How Do We Measure Success? Data Needs for the Changing Health Workforce

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1 How Do We Measure Success? Data Needs for the Changing Health Workforce Joanne Spetz, PhD, FAAN University of California, San Francisco March 2, 2012

2 What Do We Need to Know? Do we have enough nurses? Supply, demand, forecasts How is our education system doing? Enrollments, graduations Advancement of education What roles are our nurses playing? Practice Leadership Collaboration How is our population doing? Access to care Population health & health outcomes 2

3 Do we have enough nurses? More than a decade of severe shortage, Reports that new graduates cannot find jobs 2009-now Stories that nurses are not retiring when expected Shortages in some regions Context: Ongoing recession, high unemployment, severe regional differences 3

4 We have great data! Board of Registered Nursing surveys Biennial surveys of RNs, (2012 coming) Annual Schools Report Biennial forecasts of supply and demand UCSF/HASC/CINHC Employer Demand surveys Supported by Moore Foundation Expanded collaboration underway Other national and state data sources Bureau of Labor Statistics surveys Employment Development Department analyses 4

5 BRN surveys Survey of RNs, ,000 RNs sampled, ~65% response rate Paper survey with option to do online survey Annual Schools Survey, Online survey of all nursing programs 100% response rate 5

6 Employment rates by age, 2008 & 2010 Source: California Board of Registered Nursing Survey of RNs,

7 Reasons for not working in nursing % important or very important Laid off Difficult to find a nursing position Inconvenient schedules in nursing jobs Wanted to try another occupation Dissatisfaction with the nursing Other dissatisfaction with your job Dissatisfied with benefits Salary Job-related illness/injury Stress on the job Childcare responsibilities Retired 0% 20% 40% 60% Source: California Board of Registered Nursing Survey of RNs,

8 Nurse earnings over time Source: California Board of Registered Nursing Survey of RNs,

9 Future plans of RNs 100% 90% Plan to retire 80% 70% 60% 50% 40% 30% 20% 10% 0% Under Under 35, , , , 2010 Plan to leave nursing entirely, but not retire Plan to increase hours of nursing work Plan to reduce hours of nursing work Plan to work approximately as much as now Source: California Board of Registered Nursing Survey of RNs,

10 RN Graduations are expected to drop in New enrollment Projected enrollment from 1 yr Projected enrollment from 2 yrs Graduations ,988 14,621 13,692 10, ,228 14,917 14,216 11, ,055 14,835 12,447* ,223 13,273* ,616* ,766* Source: California Board of Registered Nursing Annual Schools Report,

11 Survey of Nurse Employers, Fall 2010 Collaboration between UCSF, CINHC, and HASC survey with option to return paper survey via fax or Questions based on previous CINHC survey and National Forum of State Nursing Centers Minimum Demand Data Set recommendations Follow-up short survey conducted Spring

12 Perceptions of employers, fall

13 Differences across regions, Fall 2010 & Spring 2011 Lower number = more shortage 13

14 Rural versus urban perceptions Lower number = more shortage 14

15 Staff RN Vacancies, Fall 2010 & Spring 2011 Estimated 1,772 vacancies for new RN graduates in Fall

16 Board of Registered Nursing Forecasts of Supply Inflow of nurses Nurses with Active Licenses Living in California Outflow of nurses Share of nurses who work, and how much they work Full-time equivalent supply of RNs 16

17 The range of supply forecasts (RNs living in California) 2,500,000 2,000,000 1,500,000 Best Supply Forecast Low Supply Forecast High Supply Forecast 2009 Forecast 1,000, ,000 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce,

18 What is projected demand? National benchmarks: Employed RNs per 100,000 Bureau of Labor Statistics, forecast of 2018 demand Growth based on current hospital employment & expected growth in patient days Potential impact of PPACA 18

19 Forecasts of RN demand 400, , , , , , ,000 50,000 National 25th percentile FTE RNs/population National average FTE RNs/population California Employment Development Dept. forecast Maintain 2011 FTE RNs/Population OSHPD hours per patient day-based forecast, BRN calibration OSHPD hours per patient day-based forecast, EDD calibration 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce,

20 Best supply and demand forecasts for RNs, , , , , , , , ,000 50,000 Best Supply Forecast National 25th percentile FTE RNs/population OSHPD hours per patient day-based forecast, BRN calibration Low Supply Forecast (low count & employment) National average FTE RNs/population 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce,

21 What is happening next? UCSF, CINHC, and the Hospital Associations is analyzing Year 2 of the employer survey UCSF & BRN are nearly done with the Annual Schools Survey 2012 BRN Survey of RNs (mailed in spring)

22 What Do We Need to Know? Do we have enough nurses? Supply, demand, forecasts How is our education system doing? Enrollments, graduations Advancement of education What roles are our nurses playing? Practice Leadership Collaboration How is our population doing? Access to care Population health & health outcomes 22

23 Campaign for Action: A Dashboard to Track Progress Six measures to comprise Dashboard Dashboard to reveal progress and gaps towards implementing IOM recommendations Dashboard and Issue Brief to be publicly available on

24 What Does a Dashboard Do? Dashboards provide concise data Dashboards are linked to goals and actions Dashboards are accurate Dashboards have the data you need

25 Indicator 1: Education Percentage of employed nurses with a baccalaureate degree in nursing or higher degree Source: American Community Survey Public Use Microdata Sample Higher degrees don t have to be in nursing

26 Additional Education Indicators Number and percent of first-time NCLEX takers with BSNs (Source: NCSBN) Percent of new RN graduates by gender and by race/ethnicity (Source: IPEDS) California has BRN Annual Schools Reports Percent of hospitals that have implemented RN Residency programs (Source: RWJF Survey of Nurse Executives) California s Action Coalition has done one survey Share of employers that offer tuition reimbursement (Source: RWJF Survey of Nurse Executives) Added to California s 2012 RN Survey

27 Indicator 2: Doctoral Degrees Total enrollments in nursing doctorate programs Source: American Association of Colleges of Nursing Includes both DNP & PhD

28 Additional Education Indicators Number of people receiving nursing doctoral degrees (PhD and DNP) annually (Source: AACN) BRN Annual Schools Report Number of nurses with doctorate degrees (Source: ACS) BRN Survey of RNs Diversity of nursing doctorate graduates (Source: AACN & IPEDS) BRN Annual Schools Report

29 How to Measure Progress toward the RWJF BSN Goal Need to measure: Current education mix Education mix of new grads RNs who are advancing their education

30 State-level Estimates TOTAL COUNT State survey data HRSA: National Sample Survey of RNs 2008 Census: American Community Survey 2009 California , , ,441 Florida , , ,427 Texas , , ,637 BSN COUNT California , , ,801 Florida ,732 61,371 65,933 Texas ,809 85,988 79,303

31 State-Level Education Data Pre-license BSN State surveys IPEDS RN to BSN Total BSN Total BSN California 3,255 1,374 4,629 4,638 Florida 2,189 1,286 3,475 3,795 New York 3,074 1,443 4,517 4,490 Texas 3,575 1,175 4,750 4,655

32 What Do We Need to Know? Do we have enough nurses? Supply, demand, forecasts How is our education system doing? Enrollments, graduations Advancement of education What roles are our nurses playing? Practice Leadership Collaboration How is our population doing? Access to care Population health & health outcomes 32

33 Indicator 3: Practice Number of states that allow nurse practitioners to practice independently Source: National Council of State Boards of Nursing

34 Additional Practice Indicators Number of hospitals with Magnet status (Source: American Nurses Credentialing Center) Number of nurse-led clinics (Source: National Nursing Centers Consortium membership count) Number and percent of nurse-managed clinics in underserved areas (Source: National Nursing Centers Consortium geocoded listing of NMCs) Number of states that allow NPs to prescribe independently (Source: NCSBN) Number of states that allow nurse midwives to practice independently (Source: NCSBN)

35 Indicator 4: Interdisciplinary Collaboration Percent of required nursing courses that offer clinical or simulation experiences for both entry-level RN students and one or more types of other graduate-level health professional students, for top 10 nursing schools (by US News and World Report rankings) that also have other graduate-level health professions schools Source: To be compiled from websites & direct contact with the schools

36 Additional Collaboration Indicators Number of articles in top 10 health & healthservices research journals co-authored by nurses & authors from other disciplines Source: INQRI program evaluation

37 Indicator 5: Leadership Percent of hospital boards that include an RN Source: American Hospital Association

38 Additional Leadership Indicators Percent of boards that include an RN for the top five insurance companies, pharmaceutical companies, health care systems (e.g. HCA), and health technology companies Source: Original data collection Percent of pre-specified leadership positions in government agencies held by RNs nationally Source: To be compiled by CCNA Can we get this for California?

39 And A Workforce Indicator in the RWJF Dashboard Diversity of current RN workforce Source: American Community Survey Public-Use Microdata Sample California BRN Survey of RNs

40 What Do We Need to Know? Do we have enough nurses? Supply, demand, forecasts How is our education system doing? Enrollments, graduations Advancement of education What roles are our nurses playing? Practice Leadership Collaboration How is our population doing? Access to care Population health & health outcomes 40

41 How can we track population and patient health? California Health Interview Survey CALNOC hospital data on nurse-sensitive outcomes National Database of Nursing Quality Indicators CHART OSHPD data Linking gaps in nurse supply to outcomes is tricky, but must be assessed! 41

42 Indicator 6: Data Number of states that have adopted and/or implemented standardized minimum data sets for nursing supply Source: Forum of State Nursing Centers California s BRN Surveys of RNs gather similar, and richer, data

43 Additional Data Indicators Number of state nursing boards that participate in the National Council of State Boards of Nursing s NurSys data system Source: National Council of State Boards of Nursing Number of states that collect race/ethnicity data about their nursing workforce Source: Forum of State Nursing Centers California already does this

44 What are our data needs? Continuation of our supply surveys (BRN) Success with the demand surveys Minimum data set? Tracking RN-to-BSN progression Employer support of education Leadership, collaboration Connecting our workforce data to population health and patient outcomes 44

45 Questions? Comments? Contact us! Joanne Spetz (desk)

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