State of the State: A Look at Florida s Nursing Shortage Mary Lou Brunell, RN, MSN Executive Director 1
FL Statute 464.0195 Established in 2001, the FCN purpose is to address issues related to the nursing shortage in Florida. Center Board of Director s Vision The Florida Center for Nursing is the definitive source for information, research, and strategies addressing the dynamic nurse workforce needs in Florida. 2
Activities to Achieve Vision Annually Nursing Education Program Survey Retention & Recruitment Projects State & Regional Status Reports Biennially Statewide Strategic Planning Licensure Data Analysis Nurse Employer Survey Supply & Demand Forecasts Economic Benefit Analysis 3
How Information is Reported for this report Statewide and, where possible, South & Southeast. 4
Increasing production alone will not resolve the nursing shortage. We must retain the experiential knowledge of senior nurses to complement the influx of new graduates, fill vacancies in high-demand settings and optimize the quality of care. Improving efforts to retain existing nurses and promoting targeted recruitment efforts will help resolve the nursing shortage in Florida. 5
Retention & Recruitment Funded Projects Successful applicants projects that identify, implement and/or evaluate effective solutions to maintaining and expanding the nursing workforce in Florida 2008 selected 9 Projects $3.70 leveraged for each $1.00 invested 2009 selected 6 Projects $13.92 leveraged for each $1.00 invested 6
Florida s Nursing Shortage (RN Full-time Equivalent) - 18,000-32,900-52,200 FTE Shortfall 7
Florida s Nursing Shortage (LPN Full-time Equivalent) 70,000 60,000 Demand Supply 50,000-7,000 FTE Shortfall 40,000 8
Why the Shortage Persists The nursing shortage is driven by an aging Baby Boom cohort requiring more health care ( demand) and simultaneous retirements from the nurse workforce ( supply). The shortage is further complicated by limitations in the ability to expand nursing education programs and problems retaining nurses in the nurse workforce ( supply). Add to this Florida s high rate of in-migration ( demand). 9
The Current Nurse Supply (Primarily reporting on Registered Nurses) 10
RN Supply as of January 2009 South/Southeast Florida Potential Nurse Workforce RNs S SE 2009 18,509 35,291 2007 17,100 35,012 + 1,409 + 279 Note: Excludes ARNPs. Actually working and # FTEs are estimates. * Eligible to work = Potential Nurse Workforce LPNs S SE 2009 5,123 10,762 2007 4,591 10,348 + 532 + 414 ARNPs S SE 2009 1,310 2,079 11
Where RNs Work Statewide 12
How Much RNs Work by Age Groups Average Age FL 47.7 yrs S 45.4 yrs SE 48.2 yrs > 40% over the age of 50 % of Nurses 35% 30% 25% 20% 15% 10% 5% 0.95 0.90 0.85 0.80 0.75 0.70 Average FTE 81% report working 36 or more hours each week. 0% 20-30 31-40 41-50 51-60 61+ % of Nurses Average FTE 0.65 13
How We Gain / Lose Nurses GAINS LOSSES New Licensee by Exam Endorsement into Florida Moved into Analysis Subset License Upgrade to ARNP or CNS Potential Nurse Workforce Moved out of Florida Change in status eligibility License Change to RN, ARNP or CNS 14
Gains and Losses 2007 to 2009 Potential Workforce RNs ARNPs LPNs Total Gains to Potential Workforce Total Losses from Potential Workforce 25,558 1,785 9,897 16,514 685 7,484 Net Change + 9,091 (5.4%) + 1,097 (10.4%) + 2,487 (4.4%) 15
2-Year Change in Potential Workforce by Region of State 16% 14% 12% 10% 8% 6% 4% 2% 0% State ARNP = 10.4% / RN = 5.4% / LPN = 4.4% Central North Northwest South Southeast Southwest ARNP RN LPN 16
The Demand for Nurses (Primarily reporting on Registered Nurses) 17
Estimated Vacancies as of June 30, 2007 RN Vacancies LPN Vacancies State S SE State S SE Hospitals 7,649 1,240 1,461 482 88 82 Skilled Nsg. Facilities 960 98 177 1,740 165 299 Home Health 1,152 273 256 519 123 126 Public Health 185 -- 59 47 -- 0 Hospice 491 -- 147 184 -- 61 Total (all groups) 10,437 1,611 2,100 2,972 376 567 18
Projected Growth in 2008 New RN Positions New LPN Positions State S SE State S SE Hospitals 4,537 568 749 325 41 63 Skilled Nsg. Facilities 81 17 4 352 40 61 Home Health 1,407 453 209 916 413 452 Public Health 55 -- 10 28 -- 4 Hospice 380 -- 73 220 -- 44 Total (all groups) 6,460 1,038 1,045 1,840 494 323 19
NOTE: Represents only the 5 industries surveyed. Vacancies & Growth Combined 16,896 2,649 870 20
Most Difficult-to-Fill Positions per Employers Rank Hospitals SNF Home Health Public Health Hospice 1 2 MSN-prepared CNS Nurse Anesthetists Geriatric NPs MSN-prepared CNS NPs (all types) Nurse Administrators Nurse Supervisors NPs and Midwives Infection Control Nurses Patient Care Coordinators 3 Nurse Administrators Nurse Administrators Oncology specialists Nurse Administrators Home Hospice Staff RNs 4 Operating Room 5 Nurse Practitioners Family / Adult NPs Rehabilitation RNs MSN-prepared CNS Home Care Staff RNs Clinic Staff Nurses Care Coordinator / Case Mgt. Quality Control Nurses In-service Educators 21
Florida s Education Capacity 22
Programs & Curriculum Options (AY 07-08) Pre-licensure Programs 78 LPN (77 Generic / 3 Bridge) 48 ADN (46 Generic / 28 Bridge) 26 BSN (22 Generic / 10 2 nd Degree) Post-licensure & Certificate Programs 23 RN to BSN 15 MSN (9 Educator) 7 RN to MSN 8 Doctoral (7 PhD / 5 DNP) 13 Certificate (7 Educator) 23
New Graduate Nurses in AY 2007-2008 6000 5000 4000 3000 22 937 2nd Degree Bridge 2000 3541 4666 323 Generic 1000 1581 0 LPN RN - ADN RN - BSN 24
New Graduate Nurses in AY 2007-2008 S & SE 25
Graduates AY 2007-08 Compared to 2006-07 6,000 5,603 5,000 4,000 3,563 3,393 4,134 2007 2008 3,000 2,000 1,906 1,904 1,000 0 LPN Programs RN: ADN programs RN: Prelicensure BSN Programs 26
Enrollment Change AY 2006-07 to 2007-08 1) Gains in ADN but not BSN 2) Gains in graduate degree practice tracks but not educator tracks % Change LPN 6.8% ADN 13.4% Pre-licensure BSN 3.3% RN-BSN 4.5% MSN: NP track 20.4% MSN: Educator track -5.3% MSN: Management track -13.0% MSN: CNS track 34.5% MSN: CNL track -36.8% Total MSN 13.6% Doctoral: Ph.D. -21.1% Doctoral: DNP 52.0% Total Doctoral 4.9% 27
Qualified Applicants Turned Away AY 2007-08 Generic LPN Bridge LPN Generic ADN Bridge ADN Generic BSN 2 nd Degree BSN # of Applicants 7,670 43 12,708 1,952 4,853 1,027 # of Students Admitted # of Applicants Turned Away % of Applicants Turned Away 5,299 39 6,157 1,213 2,417 565 2,371 4 6,551 739 2,436 462 30.9% 9.3% 51.6% 37.9% 50.2% 45.0% # of NEW Enrollees 5,006 38 6,045 1,161 2,052 342 28
Qualified Applicants Turned Away AY 2007-08 S & SE # Qualified Applicants LPN Programs ADN Programs BSN Programs S SE S SE S SE 1,425 1,108 3,570 1,713 1,442 953 # Admitted 821 1,108 771 1397 957 369 # Turned Away 604 0 2,799 316 485 584 % Turned Away 42.4% 0% 78.4% 18.5% 33.6% 61.3% 29
Factors Limiting Enrollment Growth Lack of qualified faculty applicants Lack of funds to hire faculty Limited clinical sites Lack of qualified student applicants Lack of campus resources % of Programs Reporting 0 20 40 60 LPN Programs ADN Programs BSN Programs 30
Full-time Faculty Vacancy Rates: 2007 & 2008 compared Percent of Positions Vacant 14% 12% 10% 8% 6% 4% 2% 0% 11.5% 11.4% 10.3% 6.9% 6.2% 6.2% LPN Programs ADN Programs BSN + Programs 2007 Vacancy Rate 2008 Vacancy Rate 31
Full-time Faculty Vacancies & Growth S & SE 41 13 25 22 18 4 32
Number of Enrolled Students per FT Faculty 25 20 15 10 11.75 13.75 16.62 19.1 9.31 2007 2008 9.33 5 0 LPN ADN BSN 33
What Does it All Mean? 34
Our Current Pipeline Is Not Sufficient Average hours worked per week declines dramatically with age & RNs > age of 50 = nearly 40% of all FTE positions. Inadequate # of young nurses to compensate for large cohort of RNs approaching retirement. More than 10,000 qualified applicants turned away from RN programs in one academic year. Hardest to fill positions require experience &/or an advanced degree. 35
Our Current Faculty Pipeline Is Drying Up Enrollment declined in nursing education master s tracks by 5% and in Ph.D. programs by 52%. Number of students per Full-time Faculty has increased by 3 in ADN programs. Faculty salaries do not compete with market value. 36
We are Not Gaining Ground Net Change over a 2-year period of 9,091 RNs /1,409 S / 279 SE 65% of gains through examination, endorsement, etc. lost due to failure to renew, relocation out of FL, etc. 37
Strategic Solutions Though critical to success, expanding education alone is inadequate. Action must be directed toward increasing retention and improving work environments. Issues vary by geographic region of the state. 38
Why it Matters Resolving the nursing shortage in Florida has a clear positive impact on patient safety, nurse satisfaction, and Florida s economy: If the 13,494 estimated nurse vacancies in 2007 were filled, Florida would realize an increase of over $700 million in annual revenues from spending on goods and services alone. The combined cost of annual turnover for RNs and LPNs was estimated at over $1.4 billion in fiscal year 2006-2007. 39
Is the current economic downturn reducing demand? Yes, temporarily. Demand will resume its upward soar as The economy recovers and Florida s strong in-migration resumes. Those who deferred retirement or increased hours of work return to normal life patterns. The population continues to age. Demand may, in fact, resume at a greater pace as those who deferred care return to the health system by choice or by need. 40
Recommendation: Stay the Course! Do More! Funding for education is critical Continue expansion where need exists Incentivize nurses to become educators Develop alternatives to direct clinical experiences (utilize the allowed 25% of simulation hours) Increased focus on retention of faculty and nurses providing direct patient care Accommodate the aging nurse population Enhance the education to practice transition 41
For More Information Florida Center for Nursing 12424 Research Parkway Suite 220 Orlando, FL 32826 407-823-0980 NurseCtr@mail.ucf.edu www.flcenterfornursing.org 42