California RN Workforce: LA and Orange Counties (Regions 8 & 9) Update on the Projected RN Shortage & Setting of Educational Capacity Targets
LA & Orange Counties Region 8 and 9 Planning Meeting Welcome, Introductions, and Outcomes Review of Data and Educational targets Discussion
Outcomes of Meeting Share outcomes of education capacity target setting process with Deans/Directors and CNOs Begin the dialogue for building regional educational capacity to reach educational capacity targets through strategically driven actions Although state level actions are needed, actions that are going to make long term and enduring differences will occur at the local level driven by local stakeholders
California Institute for Nursing & Health Care CINHC is a nonprofit independent organization established to provide a forum to convene diverse groups of stakeholders to address state wide nursing issues that impact the health of Californians.
CINHC Program Areas Create a comprehensive and strategically-driven nursing workforce plan for California Build educational capacity Increase diversity of workforce Provide leadership development
What CINHC is Doing to Address the RN Shortage Developing a strategic plan to address the shortage Master Plan Sponsoring projects that support building educational capacity BANRC Working with policy makers, key agencies, and associations to address shortage Convening diverse stakeholder groups, serving as a catalyst for action Building a coalition of diverse stakeholders
Master Plan Development FOCUSED AREAS: Data Diversity Education Nursing Practice Recruitment Work Environment
CINHC Initiatives that Support Regional Planning BANRC CCPS, CFRC, RSC KT Waxman, Nikki West, FCCC partners Education White Paper Jan Boller Faculty Development Project Diane Welch Diversity Plan Bonnie Adams, Barbara Napper Southern California Coordinator Pat Chambers
UniHealth Grant 2 year grant which funds CINHC s Southern California Coordinator Serves as a catalyst for regional planning Outcomes Regional planning Flo s Cookie jar
Radical actions are required to meet the state s need for nurses Consider this: California is growing with many counties experiencing soaring population growth There were 580 RNs per capita in 2004, CA was ranked 50 th in the nation 1 The current RN population is nearing retirement so replacement needs must be factored average age of the working nurse is 47.7 years 47% of qualified nursing school applicants are not enrolled due to lack of capacity 7
California s population forecast is twice the expected RN growth The state s population will expand by 29% over the next twenty years RN workforce growth will only be 13.5% Population Increase 2000 to 2020 2 30% 25% 20% 15% 10% 5% 0% All RNs
Regional Report Card States RN Jobs/100,000 population Letter Grade/No of States A 2 B 6 C+ 12 C 20 C- 6 D 4 F 0 Number of State 25 20 15 10 5 0 Distribution of Grades across the 50 states A B C+ C C- D F Letter Grade
California P/MSAs Grades Compared to the States Grades Combined Letter Grade Spread of 50 States and 24 California MSAs and PMSAs 25 50 States 20 15 24 California MSAs and PMSAs 10 5 0 A B C+ C C- D F Letter Grade
Goal for the California Nursing Workforce NATIONAL AVERAGE 70%: 580 Current/Threshold 90%: 743 Progress Target 100%: 825 Target per 100,000 population 2
Target: National Average CA RN Projections 6 35000 30000 25000 20000 15000 10000 Current 90% 100% 5000 0 2005 2010 2020 Note: current is 580; 90% is 743; 100% is 845 RNs employed per 100,000 population
Assumptions for Setting Educational Targets Assumes: 1. Utilization rates remain the same 2. Migration rates remain constant 3. Annual graduation rate same as in 2005 4. RN workforce aged 5. Population growth is major variable 6. 2004 National Average is benchmark
Statewide Shortfall 70% of National Average 580 RNs/100,000 2005 + 10,973 2010 + 11,983 2020 20 90% of National Average 743 RNs/100,000 2005 49,812 2010 52,960 2020 72,534 Current Ratio of employed RNs = 607/100,000 (per Spetz, best estimate, ) 100% of National Average 825 RNs/100,000 2005-79,930 2010-85,152 2020-108,512
Statewide Short Fall (cont) 2004 RN/100,000 580 2005 graduates 6,598 Target national average of 825 RNs/100,000 2020 population growth 29% 2020 shortfall of RNs - 108,512 Annual increase to meet 2020 demand 7,234 % increase of educational capacity to meet 2020 demand 110%
The RN disparity presents greater challenges for some due to population growth Region 8 (LA) averages 14.5% growth but Ventura forcast is 22.5% Region 9 is forcast at 41%. Orange 23.5%, Riverside 72%, San Bernadino 43% 80% 60% 40% 20% 0% Population Growth 2000 to 2020: CA and select regions 2 Population CA Region 8 Region 9 LA/Long Beach Ventura Orange Riverside San Bernadino
Region 8 & 9 RN Workforce Projected Annual RN needs through 2014 - EDD 3 At current RN per capita rate: 2569 new RNs are needed each year for LA County 701 new RNs for Orange County 135 new RNs for Ventura County Area % Change Growth Needs Replacement Needs Total Los Angeles 20.5 1272 1297 2569 Orange 24.3 377 324 701 Ventura 23.2 71 64 135 San Berna Unavailable - - - Riverside Unavailable - - - Source: Occupational Projections of Employment-Registered Nurses 2002-2014 California LaborMarketInfo, Data Library http://www.labormarketinfo.edd.ca.gov
LA/Orange Counties RN Workforce Report Card CINHC 4 Regional grade range from C- to F P/MSA RN jobs/ Grade National average was 787 California average 622 the most common grade was D Los Angeles/ Long Beach Orange Cnty 100,000 646 611 C- D Report Card infers that region is between 60 to 70% of the national average Ventura Riverside/SB 430 477 F D
Region 8 & 9 RN Workforce National Average Target Currently utilizing RNs at 70% of National Average, Region 8 (LA/Ventura) shortfall of RN is 6,369 Region 9 (Orange County/Riverside/SB) had an excess at 70% of 2,463 but with a pattern of commuting nurses into LA To maintain current utilization rate Region 8 will need: 4,380 more RNs in 2010 +1522 Reg 9 3,456 more RNs in 2020 2066 Reg 9 At the national average 2005 Reg 8.-33,483 Reg 9-14,546 2010 Reg 8-32,345 Reg 9-17,148 2020 Reg 8-32,625 Reg 9-23,445
Consider Educational Capacity To meet National Average Target Additional graduates needed each year to catch up to targets by 2020 70% of Natl Avg. (Current State) # % 100% Natl Avg. (Target) # % Region 8: 230 13% 2175 119% LA/Ventura Region 9: 137 14% 1563 158% Orange, Riverside San Bernadino
Considerations for Setting Regional Targets Population growth Demographics of population Healthcare delivery system Insured/uninsured population Nursing educational capacity Undocumented residents Age of nursing workforce Mandated staffing ratios Other?
LA RN Workforce 2005/ Hospital Survey HASC/CINHC 5 Participants Average vacancy rate Turnover rate New graduate retention: at 6 months at 12 months at 2 years Foreign recruitment engaged in foreign recruitment considering Region 8 Region 9 State Avg 50 23 14% 14% 12% 8% 13% 9.4% 63% 61% 71% 61% 82% 72% 47% 47% 57% 26% 18% 35% 11% Source: HASC/CINHC 2005 Report: Building Education/Service Partnerships, Hospital Study 2005
Current LA/Orange RN Workforce BRN 2004 8 85% of RNs are already in the workforce 30% of RNs are >55 years old 56% White, 8% Hispanic, 27% Asian, and 5% Black 93% Female 30% have BSN, 48% ADN, 21% Diploma and <1% EML as initial education 7% have MSN, 36% BS, 65% ADN or Diploma as highest education 55% were educated in CA, 22% other states, and 23% were educated outside the US Source: CA BRN 2004 Workforce Data
LA/Orange County Current Workforce (cont) In the Southern California Region: 75% of RNs work at least 33 hours per week 63% work in acute care hospitals 16% work in out of hosp settings 4% work in skilled and extended care settings In the next 5 years: 22% plan to reduce their hours 12% plan to retire 4% plan to leave nursing
LA/Ventura Educational Capacity BRN 2005 ELM, 3 There were 31 prelicensure programs Number of graduates in 2005: 1,826 ADN 1,467 BSN - 359 ELM - 0 Accl BSN, 4 BSN, 5 Accl AD, 1 LVN/AD, 1 AD, 21 Source: CA BRN 2004/05 School Data
Orange, Riverside, San Bernadino Educational Capacity BRN 2005 There were 13 prelicensure programs Number of graduates in 2005: 999 ADN - 862 BSN - 137 BSN, 1 Accl BSN, 1 ELM, 0 AD, 11 Source: CA BRN 2004/05 School Data
LA, Ventura Applicant Success Prelicensure Applicants Qualified Applicants Enrolled Applicants Success Rate # # % Generic ADN 3554 1548 44% BSN 1178 520 44% ELM 86 81 94% Total 4818 2149 45% Source: CA BRN 2004/05 School Data
Orange, Riverside, San Bernadino Applicant Success Prelicensure Applicants Qualified Applicants Enrolled Applicants Success Rate # # % Generic ADN 3757 872 23% BSN 243 84 35% ELM - - -% Total 4000 956 24% Source: CA BRN 2004/05 School Data
Region 8: LA, Ventura Student Retention Rate 2004-2005 Students ADN BSN ELM* Total scheduled to complete 04/05 1945 100% 408 100% na 2353 100% Student dropped out 596 31% 39 10% na 635 27% Students completed on schedule 1264 65% 339 83% na 1603 68% Completed Behind sched.-began prev yrs 203 20 na 223 na Total Completions** 1467 % 369 % na 1826 % Attrition Rate 35% 17% 32% *ELM did not report **Scheduled completions plus those behind schedule from previous years Source: CA BRN Schools Data
Region 9: Orange, Riverside, SB Student Retention Rate 2004-2005 ADN BSN Total Students scheduled to complete 04/05 1082 100% 173 100% 1255 100% Student dropped out 236 22% 20 12% 256 20% Students completed on schedule 778 72% 108 62% 886 71% Completed Behind sched -began prev yrs 84 29 113 na Total Completions* 862 % 137 % 999 % Attrition Rate 28% 38% 29% * Scheduled completions plus those behind schedule from previous years Source: CA BRN Schools Data
Regional Planning Challenges What drives area s demand for RNs? Including nonacute care hospital demands? What should be region s target for RNs employed/capita? Is C grade appropriate for Area? Or should it be lower or higher? What impact will increase retention in nursing programs and NCLEX success have on increasing RNs into workforce? What impact will increase retention in workplace have on RNs available? What should the region s educational capacity be to reach workforce targets? How will education be transformed to reach capacity targets?
Next Steps Convene representative subcommittee to craft a document that would meet the agreed upon targets meet on regularly scheduled basis Begin dialogue on how to strategically meet regional targets for educational capacity develop a regional strategic plan Determine actions best addressed at regional and/or state level Determine actions addressed at local level Build a profile of each school and identify schools specific strategies
Contact Information Pat Chambers RN,BSN,MBA Regional Coordinator/Southern California California Institute for Nursing & Healthcare 515 South Figueroa, Suite 1300 Los Angeles,Ca 90071 pat@cinhc.org www.cinhc.org
Sources 1. March 2004: Preliminary Findings from the National Sample Survey Of Registered Nurses. HRSA. 2. State of California Dept. of Finance Census & Spetz, J. Regional Forecasts of the Registered Nurse Workforce in California, SF: UCSF Center for California Health Workforce Studies, Center for the health Professions, August. 3. Occupational Projections of Employment-Registered Nurses 2002-2012 California LaborMarketInfo, Data Library http://www.labormarketinfo.edd.ca.gov 4. CINHC Regional Report Card, May 5. HASC/CINHC 2005 Report: Building Education/Service Partnerships, Hospital Study 2005 6. Spetz, J. Ibid 7. BRN Workforce Data 2004 Survey of Registered Nurses 8. 2004-2005 BRN Nursing Education Program Survey Report