2014 Nursing Supply and Demand Study Acute Care Greater Cincinnati Health Council 2100 Sherman Avenue, Suite 100 Cincinnati, OH 45212-2775 Phone: (513) 531-0200
Table of Contents I. Introduction and Executive Summary... 3 II. Hospital Survey (Demand)... 5 A. Registered Nurse (RN) Staff Turnover (2004-2013)... 5 1. Reasons for Leaving Position.... 5 2. Registered Nurses Hired by Level of Experience.... 7 3. Registered Nurses Hired by Specialty Area... 7 B. Registered Nurse Staff (2006 2014 comparison)... 8 1. RN Positions: Full / Part-time and Vacancy Rates.... 8 2. RN Positions: Specialty Areas... 9 3. RN Positions: Role... 9 C. Registered Nurse Staff Demographics (2006 2014 comparison)... 10 1. Age Distribution for Registered Nurses.... 10 2. Race and Ethnicity for Registered Nurses.... 10 3. Gender... 11 4. Hospital RN Educational Level... 11 III. Schools of Nursing Survey (Supply)... 12 A. Students... 12 1. Program Admissions... 12 2. Student Demographics... 12 3. Student Retention... 14 4. Pass Rates for the NCLEX Examination... 14 5. Placement of Graduates... 15 B. Concerns Limiting Program Capacity... 15 C. Faculty... 16 1. Positions... 16 2. Demographics and Age... 16 3. Faculty Compensation... 17 4. Faculty Changes and Attriton... 17
I. Introduction and Executive Summary The purpose of the Health Council s 2014 Nursing Supply and Demand Study 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: Gather regional data on current nursing faculty, student admission and retention, nursing work force and work force needs. Compare 2014 results to the 2006, 2008, 2010 and 2012 Supply/Demand studies. Hospital and school survey data were collected between September and December 2014. 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: More new nursing graduates were hired in 2013 and 2014. Record numbers of new graduate nurses were hired in 2012 and 2013 with new graduates representing more than 40 percent of all nurses being hired. This is an increase compared to 2010 and 2011 in which fewer than 30 percent of all nurses hired were new graduates. As a result of an influx of new graduates, hospitals have also seen a spike in the number of nurses in the 25-34 age group. More than 30 percent of all nurses are between the ages of 25-34, and there are now more nurses in that age group than any other age group. Retirements have also increased in just the last year. The 2013 RN retirement rate jumped to 0.93 percent, up from 0.77 percent in 2011 and 0.51 percent in 2010. Retirements are expected to increase in future years more than 17 percent of the region s RNs are age 55 and older. Nursing education levels show sharp increases. The number of nurses with bachelor s degrees increased to 50 percent in 2014, up from 43 percent in 2012 and 33 percent in 2008. The number of nurses with master s degrees also climbed considerably to 20 percent in 2014, up from 8 percent in 2012 and only 3 percent in 2008. 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. New National Council Licensure Examination (NCLEX) passing standards implemented in 2013 has impacted the percentage of nurses passing the NCLEX on the first attempt. In December 2012, the National Council of State Boards of Nursing voted to raise the passing standard for the NCLEX examination effective April 2013. The impact of these new passing rate standards has resulted in a downward trend in pass rates throughout both our community and across the nation. In 2006, 89 percent of local graduates passed the NCLEX Examination on the first attempt, but 2014 was a new low in which only 81 percent of local graduates passed the NCLEX Examination on the first attempt. Nationally, the pass rate, which historically has hovered just under 90 percent, also saw a sharp decrease to 83 percent. Page 3 of 17
Hospitals that participated in the study include: The Christ Hospital Cincinnati Children s Hospital Medical Center Highland District Hospital Margaret Mary Health Summit Behavioral Healthcare TriHealth UC Health Nursing schools that participated in the study include: The Christ College of Nursing and Health Sciences Cincinnati State Technical and Community College Galen College of Nursing Gateway Community and Technical College Good Samaritan College of Nursing and Health Science Miami University Mount St. Joseph University Northern Kentucky University University of Cincinnati College of Nursing University of Cincinnati Blue Ash College Xavier University Page 4 of 17
II. Hospital Survey (Demand) A. Registered Nurse (RN) Staff Turnover (2004-2013) 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 2006 and 2007, significantly more RNs changed to full-time status and decreased their part-time status. However, starting in 2008 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 greatly improved in 2013-14. 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 1. Figure 1. Percentage of registered nurses who changed from part-time to full-time or fulltime 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 2012 and 2013 left for Other reasons such as relocation and personal reasons. (See Figure 2.). More nurses were fired and/or terminated in 2012-13 than any year since 2007. More than 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 2014 survey concurred with these figures and indicated that the average age of retirement for RNs in Cincinnati was 64. However, delays in retirement age might occur as a result of inadequate retirement savings. According to a 2014 Transamerica Retirement Survey, 65 percent of baby boomers indicated they plan to work until they are at least 65 due to insufficient retirement savings. Page 5 of 17
Figure 2. Reasons for leaving the hospital position are compared for years 2004 2013 Figure 3. Hospital RN Retirement Rate 2009 2013 Page 6 of 17
3. Registered Nurses Hired by Level of Experience Record numbers of new graduate nurses were hired in 2012 and 2013 with new graduates representing more than 40 percent of all nurses being hired. This is a sharp increase from 2010 in which 20 percent of new graduate nurses were hired. 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. Figure 4. Percent of new RN hires by type of new hire for the years 2004-2013 3. Registered Nurses Hired by Specialty Area The percentages of RNs hired for a specialty area were similar for 2012 and 2013. 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. Figure 5. Percentage of Registered Nurses hired by specialty area. M/S (Medical/Surgical); CC (Critical Care); OR (Operating Room); Ob/Gyn (Obstetrics/Gynecology); Psych (Psychiatric) Page 7 of 17
B. Registered Nurse Staff (2006-14 Comparison) 1. RN Staff Positions: Full / Part-time and Vacancy Rates Vacancy rates for registered nurses have settled in at just over four percent each of the last two years since 2012, and many factors will likely increase vacancy rates. This includes older nurses heading for retirement, an aging population and further implementation of the Affordable Care Act driving up the demand for patient care due to increasing numbers of insured individuals, particularly in community settings. See Figure 6 and Figure 7. Figure 6. Percentage of full-time versus parttime positions for years 2006, 2008, 2010, 2012 and 2014 Figure 7. Vacancy rates based on the Health Council s annual vacancy survey Page 8 of 17
2. RN Staff Positions: Specialty Areas As shown previously in the 2012 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 8. Figure 8. Percent of specialty RN staff for years 2006, 2008, 2010 and 2012. 2. RN Staff Positions: Role The proportions of RN staff by role are consistent from 2006 to 2014 (see Figure 9). Approximately 80-90 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 eight 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. Figure 9. Percent of RN positions by role Page 9 of 17
C. Registered Nurse Demographics (2006-14 Comparison) 1. Age Distribution for Registered Nurses Hospitals have seen a slight increase in nurses in the 55-64 and 65+ age groups, and they have also seen a big jump in nurses 25-34 years of age (see Figure 10). Meanwhile, much of the percentage drop is with middle-aged nurses in the 35-44 and 45-54 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. According to the Health Council s vacancy survey, the average age of RNs who retired was 64. 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 50 or older, which is in line with the American Association of Colleges of Nursing figures which show that nurses in their 50s represent one-fourth of the total nursing work force nationally. Figure 10. Percent of RN age distribution for years 2006, 2008, 2010, 2012 and 2014 2. Race and Ethnicity for Registered Nurses There was little change in race/ethnicity distribution from 2006 through 2014, with non-hispanic white RNs representing more than 90 percent of the distribution. (See Figure 11) Non-Hispanic blacks represent 6 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; 0.3 percent are American Indian or Alaska Native; and 1.4 percent categorize themselves as two or more races and non- Hispanic. Figure 11. Percentage of Registered Nurses by Race/Ethnicity/ Gender for 2006, 2008, 2010, 2012 and 2014 Page 10 of 17
3. Gender The percentage of males employed in local hospitals was 7.3 percent in 2014, which represents a slight increase over the 7 percent rate in 2012. 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 1980, there were 45,060 male nurses, according to the Institute of Medicine report; by 2004, that number jumped to 168,181. Today, men comprise just over 7 percent of all RNs, and that number is projected to continue to show signs of slow growth. 4. Hospital RN Educational Level Education levels for RNs have sharply increased over the last several years. (See Figure 12.) The number of nurses with bachelor s degrees spiked to more than 50 percent, and the number of nurses with master s degrees increased to 20 percent in 2014, up from 9 percent in 2012. With several Magnet hospitals in our region, the region is experiencing the expectation that nurses in these organizations are continuing 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. Locally, some hospitals now prefer to hire RNs with a bachelor s degree, and the growth of professional RN students suggests that numbers of those with bachelor s degrees or higher is 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. Figure 12. Percentage for educational levels of hospital RNs in 2008, 2010, 2012 and 2014 Page 11 of 17
III. Schools of Nursing (Supply) A. Students 1. Program Admissions The overall percentage of qualified applicant students who were admitted to nursing schools has been steady since 2011. A small number of programs show a waiting list, although the waiting list numbers have declined in recent years. Figure 13. The percentage of qualified applicant students who were admitted to nursing schools for the years 2005-2014 2. Student Demographics In 2012 and 2013, the age distribution of overall nursing students showed a significant decline in the number of young students in the 17-24 age range, but this was offset by a sharp increase in the number of students in the 25-34 age range. Participating schools reported an increase in the number of MSN students, which supports hospital data showing that nurses are becoming further educated. However, for two-year and bachelor programs only, the age distribution of students is more in-line with traditional expectations; in the 2014-15 admission year 67 percent of students admitted were in the 17-24 age bracket compared to 21 percent of admitted students in the 25-34 age bracket. The race/ethnicity of admitted students shows that diversity remained steady in 2012 and 2013 compared to previous years. 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. The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations. Page 12 of 17
Figure 14. Percent of age groups for nursing students admitted for academic years Figure 15. Percent of nursing student admission by race and ethnicity for academic years 2005-2014 Page 13 of 17
3. Student Retention Retention rates for the academic school years of 2006, 2008, 2010, 2012 and 2014 are shown in Figure 16. Student retention for first year students increased in 2014, however, all other student years saw slight retention declines. The primary reason identified by nursing schools for attrition was students inability to meet academic expectations, which is consistently cited as the number one reason for student attrition. Figure 16. Percent retention for nursing students in Academic Years 2006, 2008, 2010, 2012 and 2014 4. Pass Rates for the NCLEX Examination Figure 17. Pass rate of nursing graduates passing NCLEX examination on the first try for the years 2006, 2008, 2010, 2012 and 2014 In December 2012, the National Council of State Boards of Nursing voted to raise the passing standard for the NCLEX examination effective April 2013. The impact of these new passing rate standards is reflected with our community and national trends. In 2006, 89 percent of local graduates passed the NCLEX Examination on the first attempt, but 2014 was a new low in which only 81 percent of local graduates passed the NCLEX Examination on the first attempt. Nationally, the pass rate, which historically has hovered just under 90 percent, also saw a sharp decrease to 83 percent. Page 14 of 17
5. Placement of Graduates In 2013, the percentage of new graduates who were hired into hospital settings dipped to 68 percent as more new graduate nurses were hired into other health care settings outside the hospital; the previous survey reading in 2011 reported that 80 percent of new graduates were hired into the hospital setting. The expectation is that this trend will continue as implementation of the Affordable Care Act 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. B. Concerns Limiting Program Capacity Factors limiting program capacity were rated as: 4 (critical), 3 (major), 2 (moderate), 1 (minor) and 0 (none). The comparison of concerns for 2006, 2008, 2010, 2012 and 2014 are shown in Figure 19. Clinical placement concerns continue to be the greatest concern in 2014, however, it is important to note that 2014 participants reflected less concern across the board for all four factors limiting program capacity. 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 9,651 placements utilizing the Health Council s TNRC system during the 2014 academic school year. Locally, many programs utilize high-fidelity simulated clinical experiences to supplement hospital setting clinical teaching. Two-year programs averaged 16 high-fidelity simulation hours in the first year and 17 high-fidelity simulation hours in the second year. However, four-year programs offered much less high-fidelity simulation hours during their first years 2 hours but then had increased offerings of 8 hours in the second year. Fouryear programs elected to have the bulk of their high-fidelity simulation hours occur during the third and year with an average of 14 hours in the third year. The fourth year of the program included 10 hours. Figure 18. Average rating (0 4) for concerns limiting program capacity for Academic Years 2006, 2008, 2010, 2012 and 2014 Page 15 of 17
C. Faculty 1. Positions In 2014, there were 602 faculty positions (filled and unfilled positions) with a vacancy rate of only 2 percent. The vacancy rate has dropped considerably since 2006 when it was 12 percent, and it has now regressed back to its level in 2010 when it was just 3 percent. Meanwhile, the percentage of full-time faculty decreased slightly in 2014 compared to 2012, and the 2014 faculty turnover rate was 10 percent. Figure 19. Percent full-time and part-time faculty status for 2006, 2008, 2010, 2012 and 2. Demographics and Age Figure 20. Percent of faculty in age categories for years 2006, 2008, 2010, 2012 and 2014 The faculty age distributions for 2014 indicate an increase in older faculty over the age of 60 but fewer faculty members age 50-59 (see Figure 19). Faculty members age 60 and over increased to 22 percent in 2012 from 20 percent in 2012, but faculty members age 50-59 decreased to 42 percent in 2014 from 49 percent in 2012. These figures suggest that nearly twothirds of the nursing faculty in regional nursing schools is over the age of 50, and this trend highlights the need nurses with advanced education to replace soon-to-be retiring faculty. Page 16 of 17
3. Faculty Compensation The average starting salary for full-time faculty in 2014 was $62,847 compared to $60,837 in 2012. The average hourly rate for part-time faculty in in 2014 was $42.12 compared to $36.18 in 2012. 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 & Attrition The percentage of faculty who left their position due to retirement increased slightly in 2014 compared to 2012, and retirements are expected to increase in future years (See Figure 20). 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. Figure 21. Percent of educators who left the position or retired for academic years 2006, 2008, 2010, 2012 and 2014 Page 17 of 17