Examining New York State Nurses in Western NY and the Finger Lakes

Transcription

1 Examining New York State Nurses in Western NY and the Finger Lakes A Western NY and Finger Lakes Regional Analysis of Nursing Graduations, Carol S. Brewer, Ph.D. RN FAAN Director of Nursing, New York State AHEC System, Associate Dean for Academic Affairs and Professor, School of Nursing University at Buffalo Ryan D. Cassens, M.A. Data & Technology Coordinator, New York State AHEC System, Department of Family Medicine University at Buffalo A NEW YORK STATE AREA HEALTH EDUCATION CENTER SYSTEM REPORT

2 2012 Western New York and Finger Lakes Regions Nursing Graduations Report, Based on data provided by The Center for Health Workforce Studies University at Albany, School of Public Health Authors Carol S. Brewer, PhD, RN, FAAN Director of Nursing NYS Area Health Education Center System Professor and Associate Dean for Academic Affairs University at Buffalo School of Nursing Western New York Collaborative on Nursing Workforce and Quality Ryan Cassens, MA Data and Technology Coordinator NYS Area Health Education Center System

3 2 List of Tables and Figures Figure 1 Table 1 Table 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Table 3 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Map of Western New York and Finger Lakes regions County populations List of schools of nursing by region Graduations by region Finger Lakes graduations by degree WNY graduations by degree Graduation total by institutional type Public institutions graduation Private institutions graduations WNY percent change in total graduations Finger Lakes percent change in graduations Perception of the average number of applications Percent of schools reporting number of qualified applicants turned away. Average number of acceptances Perceived number of nursing jobs reported by nursing directors Perceived number of hospital jobs reported by nursing directors Perceived number of nursing home jobs reported by nursing Directors Perceived number of home care jobs reported by nursing directors

4 3 Preface We would like to acknowledge The Center for Health Workforce Studies (CHWS) for providing data from their annual survey of applications, enrollments and graduations of New York State registered schools of nursing for Western New York (WNY) and Finger Lakes (FL). The CHWS have surveyed schools of nursing annually since Their reports are available at: Labor markets are regional, and some research supports that nurses in particular tend to stay close to home (Kovner, Corcoran, & Brewer, 2011). Thus the purpose of this report is to examine the supply of nursing trends in the Western New York and Finger Lakes regions to analyze whether our supply of new graduates is adequate to meet the local demand for nurses. This report was prepared by Carol S. Brewer, PhD, RN, FAAN and Ryan Cassens, MA. Dr. Brewer is currently the Associate Dean for Academic Affairs at the University at Buffalo School of Nursing, and Director of Nursing for the New York State Area Health Education Center (NYS AHEC) System. She participates in several nursing workforce groups in NYS, among which are the NYS AHEC and WNY Collaborative for Nursing Workforce and Quality (WNY CNWQ). These groups identified the need for this report in response to the call for better workforce data identified in the 2010 Institute of Medicine recommendation (Institute of Medicine (IOM), 2011). The NYS AHEC System is a health care workforce development initiative with effective strategies to cultivate a workforce that more closely matches the diversity of the state s population and assure that each community has enough practitioners in the right categories (especially primary care). NYS AHEC System strategies keep skills and talents in the state, contributing to the health of the economy while improving the health and well-being of all New Yorkers. The WNY CNWQ is a collaborative effort among the major health care systems in WNY and the University of Buffalo to provide data useful to plan for and improve patient outcomes and the nursing workforce in WNY.

5 4 Introduction The survey from The Center for Health Workforce Studies (CHWS) is sent out between the late fall to early spring each year to all nursing schools identified (at the time of this report, 119 schools or programs). Survey methods for this report are provided at: Since 2011, several schools of nursing have opened downstate. There are no new schools of nursing in the Western New York (WNY) or Finger Lakes (FL) areas since Please see Figure 1 and Table 1 for the counties belonging to the CHWS defined regions (black outline) and NYS AHEC service areas (grey hatch marks). Three counties in the CHWS areas are not included either the NYS AHEC or the CHWS definitions: Seneca, Schuyler, and Chemung counties. These counties are in white in Figure 1. Figure 1: Map of Western New York and Finger Lakes regions

6 5 In WNY, as enumerated by CHWS, there were seven BS schools, two of which also had AD programs, and four AD schools (n=12; see Table 2). There were four private and seven public programs. One of each has a school providing both an AD and BS programs. Five of these were public AD programs (one also provided a BS program). Brewer, Wolff, and Welch (2012) reported that in 2010 there were about 16,900 total FT and PT pre-licensure students in NYS in the respondent schools (about 40% of schools did not respond), but the authors did not do regional analyses. CHWS data shows that the overall NYS trend of graduations has been increasing since 2002, with a projected increase from 2010 to We Table 1: County populations Western NY Counties Population Allegany 48,946 Cattaraugus 80,317 Niagara 216,469 Erie 919,040 Chautauqua 134,905 Total 1,399,677 Finger Lake Counties Population Genesee 60,079 Livingston 65,393 Monroe 744,344 Ontario 107,931 Orleans 42,883 Seneca 35,251 Wayne 93,772 Wyoming 42,155 Yates 25,348 Total 1,217,156 Adapted from the US Census Bureau (2010) report in this analysis only data from For 2010 CHWS graduation and enrollment survey the response rate to the survey was 90%. Data for the non-respondents number of graduations was imputed by CHWS. CHWS estimates that about 34% of 2010 total graduates were already licensed RNs in RN completion programs (often called Associate degree (AD)-BSN, or RN to BS programs), and 16% of all RN graduates were already licensed; 77% of RNs practicing in the state received their license here. In addition, our workforce is augmented by nurses living or educated elsewhere and moving to nearby border states. Registered nurses (RNs) with AD degrees or hospital diplomas completing their bachelor s degrees are not new RNs-that is, they do not expand the supply; rather they improve the quality of the existing supply. Online RN completion programs are becoming more available and because the graduates may not be in NYS, additional information may be needed to determine where the graduates are located. For example, there is an extremely large online school of nursing in NYS for RNs who want to complete their Bachelor s degree in nursing (BS), but no way to determine how many of their graduates are in NYS or our local regions. Thus we may be underestimating the number of graduates.

7 6 In the Finger Lakes (Table 2), there were five AD and six BS programs, six of which were private and five of which were Public (n=11). Four AD schools were public. There was one AD and one BS programs in the counties not included in the WNY/FL region as we defined them (Southern Tier) and additional schools in central NY who may contribute graduates to our workforce as well. The CHWS data uses NYS Department of Education program codes, which results in counting some programs separately that are regional campuses or different program levels of the same schools (e.g. North and City campuses of Erie Community College: see Table 2). In fact many schools have multiple programs. For example, the same school may offer a BS, an AD and a RN- BS completion program. However, area totals should not be affected. Table 2: List of schools of nursing by region Western NY Region Schools School Type Finger Lake Region Schools School Type Daemen College Private-BS Fingerlakes Regional Health Private-AD D'Youville College Private-BS Keuka College Private-BS Niagara University Private-BS Nazareth College Private-BS Trocaire College Private-BS/AD Roberts Wesleyan College Private-BS *SUNY College of Technology at Alfred Public-BS/AD St. John Fisher College Private-BS *Alfred State College BSN Program Public-BS University of Rochester Private-BS Erie County Community College City Campus Public-AD Corning CC Public-AD Erie County Community College North Campus Public-AD Finger Lakers CC Public-AD Jamestown Community College Public-AD Monroe CC Public-AD Niagara County Community College Public-AD SUNY Brockport Public-BS SUNY at Buffalo Public-BS Genesee CC Public-AD Note: *CHWS counts Alfred State College and SUNY College of Technology at Alfred as separate programs but is really only one that has both an AD and BS.

8 Figure 2: Schools in regions 7

9 8 EXECUTIVE SUMMARY Key findings 1. The number of graduates added to local markets is lowered by RNs who fail the NCLEX or leave the area. However, RNs from NYS who graduated elsewhere and return add to the workforce, but we have no estimates of this number to 2010 had a flat graduation rate with an overall increase from 2005 of 500 graduates and a decline in WNY of 32 graduates. There is no estimate of RN completion graduates from online programs outside the state. 3. The WNY/FL regions graduated 410 more new RNs in 2010 than in The FL had a gradual increase in total graduates; WNY declined from Public schools graduate more RNs than private ones, in both regions. WNY leads in public school graduations, FL leads in private. 6. There was a decline in WNY in the percent change for all types of graduates from 2009 to 2010; the FL was similar except showed a slight rise in only RN-BS programs. 7. Perceived applications fluctuated downward between somewhat higher and about the same from , bumping up in 2009 then downward again from About half of the FL schools did not turn away any qualified applicants in 2006, 2007, and 10. In WNY only in 2005 were there any schools that turned away zero applicants. 9. The average number of acceptances also dropped from , reflecting perhaps a larger applicant pool. 10. The perceived strength of the overall job market weakened. From 2005 to 2010 the jobs reported by nursing directors decreased in hospitals particularly, but also nursing homes and home care. Summary: In 2010, 1,413 new graduates were added to the WNY/FL regional RN workforce, an increase of 410 additional new RNs in 2010 compared to A total of 11,355 new graduates (not previously RNs) were graduated in this 5 year period. An additional 2,922 RNs completed the BS over the 5 years, or 20.5%. While total graduations increased over the five year period, there appears to be an indication of a weakening market since The health care industry in these two regions needs to assess their need for new graduate RNs and determine if the indicated supply is adequate.

10 9 Graduations by Region Total graduations from all undergraduate programs in both regions have increased from 2005 (n=1,368) to 2010 (n=1,867) by almost 500 graduates. Removing RNs completing their BS shows an increase of new RNs of 1,093 to 1,509, or also about 500 graduates. Most of this increase was in the BS educated nurse. The greatest increase overall was between 2007 to However, the WNY area saw a decline in graduations from 2009 to 2010 from 919 to 887 graduates. Figure Graduations by Region Total Graduates FL Total Graduates WNY Total Graduates

11 10 Regional Graduations Combined FL and WNY graduations are shown in red dashed lines (both in Figure 4 and Figure 5). Combined graduations increased gradually to 2008, but leveled off in 2009 and The total number of new graduates in 2010 was 1,867. AD graduates were 950, and new BSs were 559 (29.5% of the total); an additional 358 RNs obtained their BS degree. The total number of new graduates added to the workforce in both regions who are not already RNs was 1,003 in 2005 (1,368 total-365 RN completion graduates). It was 1,413 in 2010 (or 1,867 total RN completion graduates). In the FL (solid blue lines on Figure 4), in 2010 the total number of new graduates was 980. There were 340 (36.7% of the total) new BS graduates and an additional 384 students who obtained an AD. An additional 256 RNs graduates completed their BS degree. From 2005 to 2010 the number of BS graduates increased from 175 to 340, and the number of AD graduates increased from 311 to 384. RN-BS graduates increased from 155 to 256. Figure 4 Finger Lake Graduations by Degree 2,000 1,800 1,600 1,400 1,200 1, Total AD Total BS Total BS w/ existing AD degree Total Graduates FL AD FL BS FL BS w/ existing AD degree FL Total Graduates

12 11 In the WNY area (green, solid line on Figure 5), in 2010 the total number of WNY new graduates was 887. About one third as many new BSs graduated as new ADs. There were 219 BS graduates, and an additional 566 students obtained their AD. An additional 102 RN graduates completed their BS degree. Between 2005 and 2010 the number of WNY BS graduates doubled from 102 to 219, and AD graduates increased from 505 to 566, whereas the number of BS completion graduates fluctuated from 120 in 2005 to 73 in 2007 to 102 in There was a slight decrease in all graduates in WNY. Figure 5 WNY Graduations by Degree 2,000 1,800 1,600 Total AD Total BS 1,400 1,200 1, Total BS w/ existing AD degree Total Graduates WNY AD WNY BS WNY BS w/ existing AD degree WNY Total Graduates In 2010, 1,413 new graduates were added to the WNY/FL regional RN workforce, an increase of 410 additional new RNs in 2010 compared to A total of 11,355 new graduates (not previously RNs) were graduated in this 5 year period. An additional total of 2,922 RNs completed the BS over the 5 years, or 20.5%.

13 12 Graduations by Institution Type: Public or Private There are five public AD programs and two public BS programs in WNY. The CHWS data listed two programs at Erie Community College and three programs at Alfred University independently; we classify these as one public AD and one public BS school. The FL has four AD and one BS public programs in FL. There is also a larger population in WNY than FL (Table 1). In the FL, private schools have increased graduations (279 to 525) much more than public (362 to 455), whereas in WNY public institutions have maintained their lead in graduations (449 to 573 vs. 197 to 314) (see Figure 6). In WNY both public and private graduates declined in Figure Graduation Totals by Institutional Type WNY Public FL Public FL Private WNY Private

14 13 Public Schools Graduations by Region The majority of AD schools are public institutions so it is not surprising that more AD graduates are from public institutions (n=8; total=791) than private (n=2; total =159), and more AD graduates from public schools in WNY (red lines: n=431) than FL (blue lines: n=360. See Figure 7). More BS programs are private than public, particularly in the FL. The fewest graduates are from RN completion programs. Figure Public Institutions' Graduations FL AD FL BS FL BS w/ existing AD degree FL Total Graduates WNY AD WNY BS WNY BS w/ existing AD degree WNY Total Graduates

15 14 Private Graduations by Region The FL private institutions graduate more RNs than in WNY (total n= 525 vs. 314), especially first time BS (n=275 vs. 85 respectively); very few FL AD nurses have graduated from private schools. In 2010, private schools in WNY graduated almost six times as many AD graduates (n=135) as in FL (n=24), but overall the numbers are small. New BSNs in private programs in FL (n=275) outnumbers WNY new BSNs (n=85); FL private BS completion graduates (n=226) far outnumber WNY private BS graduates (n=94. See Figure 8). Figure Private Institutions' Graduations FL AD FL BS FL BS w/ existing AD degree FL Total Graduates WNY AD WNY BS WNY BS w/ existing AD degree WNY Total Graduates

16 15 Recent Change in Total Graduations A careful examination in WNY of the percent change from year to year in total graduations (Figure 9) reveals more detail in the disturbing decreasing trend from 2009 to 2010 in all the programs except the generic BS, which decreased in 2009 and remained lower into Figure 9 WNY Percent Change in Total Graduations 60% AD 50% 40% 30% 20% 10% 0% -10% -20% -30% BS BS w/ existing AD degree Total

17 16 The picture in the FL of the percent change in graduations is more mixed. The AD graduations decreased in 2008 and rebounded , BS graduations steadily decreased since 2007, while BS completion programs decreased in 2007 but increased again through 2010 for an overall gain. The differences in the trends in the two regions are shown in Figure 9 and 10 are also shown in Figure 3. Figure 10 Finger Lakes Percent Change in Graduations 40% AD 30% 20% BS 10% 0% -10% BS w/ existing AD degree Total -20% Change in Applications, Acceptances and Job Market Schools were asked to respond to questions about their applications, acceptances and job market. Where data is missing from 2008, it is not available because of a change in the time frame about which schools were queried (The Center for Health Workforce Studies, 2010, p.14). Also, we are reporting the mean value in each chart rather than grouping by the percent of respondents reporting each value because of the small number of schools in each region (See Table 2). Schools reported their perception of the change in applications as much lower to much higher. The trend in the average value across the region reported from 2007 to 2009 fluctuated, but the perception was generally seen as higher, with a slight drop in 2007.

18 17 Figure 11 Much Higher Somewhat Higher Perception of the Average Number of Applications Finger Lakes Region Mean Value About the Same WNY Region Mean Value Somewhat Lower Much Lower Qualified Applicants Turned Away There were many non-respondents for this question (Table 3), so only the number of schools in each category and the n is reported. By 2010, a little less than half of the schools in both areas were not turning away any qualified applicants. Four or more schools in each region were turning away 80 or more qualified applicants. The majority was turning away fewer than 40 qualified applicants. Economic factors due to the recession were likely a factor, as students postponed entering nursing schools.

19 18 Table 3: Percent of schools reporting number of qualified applicants turned away Number of applicants turned away Percent of schools Finger Lakes n=10 n=9 n=7 n=5 n=13 0 0% 50% 57% 0% 46% % 33% 14% 40% 15% % 17% 0% 20% 8% % 17% 14% 0% 15% % 0% 0% 0% 8% % 33% 14% 40% 8% WNY n=7 n=6 n=5 n=3 n=11 0 0% 17% 40% 33% 45% % 33% 0% 0% 9% % 17% 40% 33% 27% % 17% 20% 0% 0% % 0% 0% 0% 0% % 17% 0% 33% 18% Average Number of Acceptances Given the perceived increase in applications, schools seemed to have leveled off their acceptances in 2010, as the average response was about the same. Overall the trend since 2007 was downward, reflecting perhaps a larger pool of applicants due to the recession.

20 19 Figure 12 Much Higher Average Number of Acceptances Somewhat Higher About the Same Finger Lakes Region Mean Value WNY Region Mean Value Somewhat Lower Much Lower Strength of the Overall Job Market. Programs reported decreasing strength in the job market from 2005 to In 2005, both regions considered the job market to be very strong, with FL reporting a slightly weaker market. Both regions reported a sharp drop in market strength from 2007 to 2010, although the FL area was slightly stronger. The hospital market was closely matched by the overall pattern in perceived job strength, whereas the home care and nursing home markets were neither as strong in 2005 nor as weak in 2010, but steadier overall. This may reflect the reality that most new graduates start in hospital jobs (Kovner et al., 2007) and only move to other job settings later in their careers. Thus the perception of job strength in those markets may either be less accurate or just less relevant to nursing schools.

21 20 Figure 13 Many Jobs Some Jobs Overall Nursing Jobs Reported by Nursing Program Directors Finger Lakes Region Mean Value Unsure WNY Region Mean Value Few Jobs No Jobs Figure 14 Many Jobs Hospital Jobs Reported by Nursing Program Directors Some Jobs Finger Lakes Region Mean Value Unsure WNY Region Mean Value Few Jobs No Jobs

22 21 Figure 15 Many Jobs Some Jobs Unsure Nursing Home Jobs Reported by Nursing Program Directors Finger Lakes Region Mean Value WNY Region Mean Value Few Jobs No Jobs Many Jobs Figure 16 Many Jobs Home Care Jobs Reported by Nursing Program Directors Some Jobs Some Jobs Finger Lakes Region Mean Value Unsure Unsure WNY Region Mean Value Few Jobs Few Jobs No Jobs No Jobs

23 22 Discussion and Conclusions This study was inspired by a local health care human resources professional who estimated needing several hundred RNs per year in the next four to five years as their workforce begins retiring and health care delivery changes is influenced by the Affordable Care Act. However, while we can provide information about new graduates in this area, we cannot completely estimate other factors. In 2010, 1, 413 new graduates were added to the WNY/FL regional RN workforce, an increase of 410 additional new RNs in 2010 compared to A total of 11,355 new graduates (not previously RNs) were graduated in this 5 year period. An additional total of 2,922 RNs completed the BS over the 5 years, or 20.5%. It is not known if this is a sufficient supply for the area. The students who are completing their BS, but already have an AD, are very likely to be nurses already working in the area and are likely to stay in the region. New graduates are more likely to move out of the area where they graduated and ADs are more likely to stay local than BS prepared RNs (Kovner et al., 2007). Some graduates will return to their homes in other parts of the state, especially NYC (and some will return here for the same reason). In addition, not all graduates will pass the NCLEX exam required for licensure in NYS. The NYS pass rate is 88.2% for BS graduates and 82.9% for AD graduates, or 86.8% overall. That means that of these 2010 new graduates, only about 1,310 are available to the workforce. However, this report provides a starting place for examining the balance between supply and demand in this part of the state. CHWS is completing the 2011 survey but that data is not available as of this report publication. Certainly, the downward trend from 2009 to 2010 for most of the programs is disturbing. It may be the perceived weakening in the job market is leading programs to reduce graduations. If, as feared by the local health care human resources professional, demand sharply increases in the next few years, we need to determine if our capacity to educate nurses can satisfy that need.

24 23 References Brewer, C.S., Wolff, D.A., Welch, C.A. (2012). NYS institute nursing schools and faculty report Foundation of New York State Nurses, Inc. Institute of Medicine (IOM). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press. Retrieved from Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S., Kim, H., & Djukic, M. (2007). Newly licensed RNs' characteristics, work attitudes, and intentions to work. American Journal of Nursing, 107(9), doi: /01.NAJ Kovner, C.T., Corcoran, S.P., & Brewer, C.S. (2011). The relative geographic immobility of new registered nurses calls for new strategies to augment that workforce. Health Affairs, 30(12), doi: /hlthaff The Center for Health Workforce Studies. (2010). Trends in New York registered nursing graduations, University at Albany: The Center for Health Workforce Studies. U.S. Census Bureau, (2010). Census Summary File 1, Table P1. Generated by Ryan Cassens at American FactFinder, www. November,7 2012

25 A NEW YORK STATE AREA HEALTH EDUCATION CENTER SYSTEM REPORT