The Nursing Labor Market in California: Still in Surplus? May 2013 - - PowerPoint PPT Presentation

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The Nursing Labor Market in California: Still in Surplus? May 2013 - - PowerPoint PPT Presentation

Aug 21, 2022 315 likes •939 views

The Nursing Labor Market in California: Still in Surplus? May 2013 Todays presenters Joanne Spetz Professor at the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco Teri Hollingsworth

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The Nursing Labor Market in California: Still in Surplus?

May 2013

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Today’s presenters

  • Joanne Spetz

– Professor at the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco

  • Teri Hollingsworth

– Vice President, Human Resources Services, Hospital Association of Southern California

  • Judee Berg

– Executive Director of the California Institute for Nursing & Health Care

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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The collaboration

  • Betty Irene Moore Nursing Initiative
  • Philip R. Lee Institute for Health Policy Studies,

University of California, San Francisco

  • California Institute for Nursing & Health Care
  • Hospital Association of Southern California

Acknowledgements & thanks to…

– California Hospital Association – Hospital Council of Northern & Central California – Hospital Association of San Diego & Imperial Counties – UCSF Staff & Interns: Tim Bates, Lela Chu, Jessica Lin, Dennis Keane, Fletcher Munksgard, Glenda Tam

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What is going on in our RN labor market?

  • More than a decade of severe shortage,

1998-2008

  • Reports of nurse surplus 2009-now

Context: Ongoing recession, high unemployment, severe regional differences

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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Survey of Chief Nursing Officers

  • Fielded by UCSF
  • Funded by Gordon & Betty Moore Foundation
  • Web-based survey with option to return paper

survey via fax or email

  • Questions based on previous CINHC survey and

National Forum of State Nursing Centers “Minimum Demand Data Set” recommendations

  • Five surveys conducted

– Fall 2010, Spring 2011, Fall 2011, Spring 2012, Fall 2012 – Spring surveys & Fall 2012 conducted solely for CNOs – Fall 2010 and 2011 included HR data

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Perceptions of employers

5.5% 4.6% 5.0%

45.0% 43.0% 29.4% 19.7% 6.6% 11.3% 17.0% 23.2% 25.6% 12.4% 20.5% 23.8%

0.5% 2.0% 5.0%

0% 20% 40% 60% 80% 100% 2012 2011 2010 High demand: difficult to fill open positions Moderate demand: some difficulty filling open positions Demand is in balance with supply Demand is less than supply available Demand is much less than supply available Other

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Differences across regions

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Lower number = more shortage

2.9 3.9 3.1 3.2 3.3 3.5 3.4 3.2 3.7 2.7 3.1 3.0 3.1 3.2 3.0 3.2 2.6 2.8 2.2 3.0 2.9

1 2 3 4 5 Sacramento & Northern CA San Francisco Bay Area Central California Los Angeles Inland Empire Southern Border California 2012 2011 2010

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Rural versus urban perceptions

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Lower number = more shortage 2.71 3.33 2.82 3.15 2.6 2.9 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Rural Non-rural 2010 2011 2012

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Differences by hospital size

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Lower number = more shortage

2.88 3.28 3.50 3.50 4.00 3.48 2.71 3.00 2.62 3.04 3.03 2.83

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Less than 100 100 - 149 150 - 199 200 - 299 300 - 399 400 or more Average ranking # of Licensed Beds 2010 2011 2012

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Change in difficulty recruiting, compared to last year, Fall 2012

10.4% 26.2% 0.6% 4.6% 61.6% 62.1% 72.1% 71.6% 28.0% 11.7% 27.3% 23.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less difficult About the same More difficult

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Change in RN employment in the past year

27.3% 22.5% 14.1% 11.5% 34.3% 49.1% 55.4% 48.8% 59.9% 47.0% 23.6% 22.1% 33.7% 23.0% 28.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Decreased employment No change Increased employment

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Changes experienced in past year

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20 40 60 80 100 120 140 Budget constraints Fewer RN retirements than… Reduction in census Less turnover of staff Decrease in use of… Current staff working more shifts Current staff converting PT to… Hiring freeze Increase in use of… Less foreign recruitment Number of responses (217 maximum possible)

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Foreign recruitment, 2010-2012

6.7% 4.0% 1.9% 0% 1% 2% 3% 4% 5% 6% 7% 8% 2010 2011 2012

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Hiring of newly graduated RNs, Fall 2012

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84.6% 82.6% 77.6% 6.7% 9.4% 12.6% 8.7% 8.0% 9.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2010 2011 2012 Do not hire ever Normally hire, but not this year Hired this year

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Hiring requirements and preferences, Fall 2011 & 2012

52.3% 4.6% 69.5% 52.3% 21.2% 53.7% 7.3% 67.9% 55.5% 21.6% 0% 20% 40% 60% 80% Minimum experience requirement Baccalaureate degree required Baccalaureate degree preferred Specific type of experience No experience required 2012 2011

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Care experience most often needed in critical care, OR, ED, L&D

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New graduate training programs, Fall 2012

  • 71% had a

residency in 2012

  • 82% developed

program internally

  • Most common

capacity is 20-30 new grads

  • Most common

length is 12 weeks

67.4% 61.4% 70.7% 32.6% 38.6% 29.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2010 2011 2012 Residency No residency

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Hiring expectations

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31.4% 23.5% 31.2% 18.6% 8.7% 17.2% 50.0% 67.8% 51.6% 0% 25% 50% 75% 100% 2010-2011 2011-2012 2012-2013 No change Hire fewer than last year Hire more than last year

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Reasons for expected increasing employment

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10 20 30 40 50 60 Increase in census Increase in bed capacity Decrease in use of traveler/contract RNs More RN retirements than expected Care model redesign Number of responses (67 maximum possible)

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Reasons for expected decreasing employment

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5 10 15 20 25 30 35 Reduction in census Less turnover of staff Hiring freeze Fewer RN retirements than expected Budget constraints Current staff working more shifts Number of responses (37 maximum possible)

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Hiring expectations for new graduates

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21.6% 22.3% 18.7% 22.3% 59.7% 55.4% 0% 25% 50% 75% 100% 2011-2012 2012-2013 No change Decrease hiring Increase hiring

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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Turnover & hiring of full-time personnel, Fall 2012

2.5% 2.9% 2.4% 2.1% 3.8% 3.7% 1.5% 3.5% 3.7% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Separations Hiring Staff RNs Other RNs New RN grads LVNs Aides

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Percent of new hires that were new graduates, Fall 2012

32.0% 6.0% 26.0% 0% 5% 10% 15% 20% 25% 30% 35% Full-time Part-time Overall

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Per diem, traveler, and agency use

0% 5% 10% 15% 20% Per diem Traveler Agency RNs 2010 RNs 2011 RNs 2012 LVNs 2010 LVNs 2011 LVNs 2012

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RN Vacancies, 2010-2012

3.4% 4.0% 3.8% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% All RNs Fall 2010 Fall 2011 Fall 2012

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Vacancy rates by position, Fall 2012

2.9% 7.1% 5.9% 3.7% 4.9% 0% 1% 2% 3% 4% 5% 6% 7% 8% Staff RNs Other RNs New RN Grads LVNs Aides

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Vacancy rates by part-time and full- time status, Fall 2012

3.5% 6.7% 5.8% 4.1% 4.7% 2.1% 1.9% 9.5% 8.0% 2.6%

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% Staff RNs Other RNs New RN Grads LVNs Aides Full-time Part-time

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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New RN Graduate Hiring Survey

  • Statewide survey of new grads conducted in fall
  • f 2012
  • Collaborators:

– CINHC – UCLA School of Nursing – Board of Registered Nursing – Association of California Nurse Leaders – California Student Nurses Association

  • Random selection of >5,000 newly licensed RNs

in CA between September 2011-August 2012

– Sample was mailed letters with invitation to complete web-based survey

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Findings from the 2012 New RN Graduate Hiring Survey

  • 46% were not yet employed as an RN

– Consistent with survey from National Student Nurses Association in Sept 2011 – 45% unemployed – American Association of Colleges of Nursing survey in 2012 (BSN degree only) – 43% unemployed

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Regional variation in unemployment

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42% 57% 52% 41% 45% 33% 44%41% 0% 10% 20% 30% 40% 50% 60% Not Working Rates LA/Ventura SF Bay Orange/Inland N CA San Diego/Imperial Central Valley Sacramento Central Coast

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Unemployment varies by education

47% 45% 41% 0% 10% 20% 30% 40% 50% AD BSN ELM

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Why are they not employed?

  • 92% no experience
  • 55% no position available
  • 35% not having BSN
  • 7% out of school too long

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For those employed…

  • 53% employed within 3 months
  • 65% reported working in “job of choice”
  • 76% are working full time
  • Employment settings:

– 66% hospitals – 11% long-term care – 8% community-based facilities – 15% other

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What are unemployed nurses doing?

  • Working in non-RN position
  • Returning to school
  • Volunteering

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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What does the 2012 RN survey tell us about employment?

82.6% 89.3% 84.2% 87.5% 86.7% 86.9% 87.4% 85.1% 17.4% 10.7% 15.8% 12.5% 13.3% 13.1% 12.6% 14.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1990 1993 1997 2004 2006 2008 2010 2012

Employed in nursing Not employed in nursing

15.5% of working nurses have more than one RN job.

Source: California Board of Registered Nursing Survey of RNs, 2012

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Share of RNs employed in nursing by age

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 30 years 35-39 years 45-49 years 55-59 years 65 + years 2004 2006 2008 2010 2012

Source: California Board of Registered Nursing Survey of RNs, 2012

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Reasons for not having RN job

2008 2010 2012 Under 55 years 55 years and older Retired 32.4% 34.9% 35.9% 8.0% 52.2% Childcare responsibilities 25.8% 21.9% 18.5% 36.9% 7.8% Other family responsibilities 33.8% 29.7% 23.8% 34.0% 17.8% Stress on the job 47.5% 35.7% 32.2% 35.3% 30.4% Salary 27.8% 20.1% 20.1% 26.0% 16.6% Inconvenient schedules in nursing jobs 26.9% 19.9% 23.6% 29.3% 20.3% Difficult to find a nursing position 8.1% 19.3% Cannot find any RN work 20.8% 35.5% 12.2% Difficult to find desired RN job 28.3% 40.6% 21.2% Laid Off * 15.7% 7.8% 7.0% 8.2%

(% reporting important or very important)

Source: California Board of Registered Nursing Survey of RNs, 2012

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Average income from all nursing positions

$31,504 $42,163 $45,073 $59,937 $73,542 $81,428 $82,134 $78,236 $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 1990 1993 1997 2004 2006 2008 2010 2012

Source: California Board of Registered Nursing Survey of RNs, 2012

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Plans for next 5 years for working RNs

14.6% 9.8% 9.7% 14.0% 15.8% 15.5% 11.5% 14.2% 6.7% 8.4% 8.5% 7.2% 9.5% 10.1% 13.1% 11.4% 32.7% 21.8% 24.7% 22.1% 21.6% 19.8% 15.2% 21.2% 46.1% 60.1% 57.1% 56.7% 53.1% 54.6% 60.2% 53.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1990 1993 1997 2004 2006 2008 2010 2012 Leave nursing/retire Increase hours Reduce hours Work as much as now

Source: California Board of Registered Nursing Survey of RNs, 2012

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What do Deans & Directors think is happening?

Type of degree 2008- 2009 2009- 2010 2010- 2011 2011- 2012 Hospital 71.4% 59.0% 54.4% 61.1% Long-term care 8.4% 9.7% 7.8% 8.3% Comm/public health 5.4% 3.9% 4.5% 3.6% Employed in CA 83.4% 81.1% 68.0% 69.6%

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Deans’ estimates of the percent of grads from the past year in each employment setting

Source: California Board of Registered Annual Schools Report, 2011-2012

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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Board of Registered Nursing Forecasts of Supply

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Nurses with Active Licenses Living in California

Outflow of nurses Inflow of nurses

Full-time equivalent supply of RNs

Share of nurses who work, and how much they work

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Changes to the model

  • New data

– Numbers of RNs – Employment patterns (2012 survey) – Graduations (2011-2012 Annual Schools Report) – Endorsement, inactive transitions, lapsed license data 2011-2012

  • More reliance on BRN data

– State-to-state migration data from 2008 NSSRN is too old

  • Adding “high” and “low” estimates for

employment rates

– High = highest rate for each age group in 2008, 2010, or 2012 – Low = lowest rate for each age group in 2008, 2010,

  • r 2012

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How do the numbers compare with the 2011 forecasts?

  • Graduations are expected to drop in 2015-2016
  • Fewer graduates projected than in the 2011

forecast

New enrollment Projected enrollment from 1 yr Projected enrollment from 2 yrs Graduations

2010-2011 14,228 13,141 14,835 10,666 2011-2012 13,691 13,895 13,340 10,814 2012-2013 12,948 13,867 11,009 2013-2014 12,601 11,176 2014-2015 11,617 2015-2016 10,557

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Source: California Board of Registered Nursing Annual Schools Reports

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The range of supply forecasts (RN FTEs)

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50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 Best Supply Forecast Low Employment Rate Forecast High Employment Rate Forecast 2011 Forecast

Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013

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Forecast of Full-time Equivalent RNs per 100,000 population

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100 200 300 400 500 600 700 800 900 Best Supply Forecast U.S. average US 25th percentile

Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013

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What is demand?

  • National benchmarks: Employed RNs per 100,000

– California was ranked 48th in 2008, 589 per 100,000 – 25th percentile: 799.5 per 100,000 – National average: 854 per 100,000 – 50th percentile: 890 per 100,000 – These were adjusted to FTEs for the supply-demand comparison

  • Bureau of Labor Statistics, forecast of 2020

demand

– 275,782 FTEs (was 236,400 FTEs for 2018)

  • RNs per patient day, 2011-2012 fiscal year

– Estimate growth in patient days based on population growth – Predict hospital RN demand from patient days forecast – Estimate overall demand as function of hospital demand

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Forecasts of RN demand

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50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 National 25th percentile FTE RNs/population National average FTE RNs/population California Employment Development Dept. forecast Maintain 2013 FTE RNs/Population OSHPD hours per patient day-based forecast, BRN calibration OSHPD hours per patient day-based forecast, EDD calibration

Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013

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Best supply and demand forecasts for RNs, 2013-2030

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100,000 200,000 300,000 400,000 Best Supply Forecast National 25th percentile FTE RNs/population National average FTE RNs/population OSHPD hours per patient day-based forecast, BRN calibration

Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013

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Goals for this webinar

  • Learn how Chief Nursing Officers perceive the

current RN labor market

  • Track the latest hospital vacancy and turnover

data

  • Understand how recently-graduated nurses are

faring

  • Link employer and nurse perceptions with

recent data on RN employment and education

  • Measure the impact of enrollment trends on

forecasts of future supply and demand

  • Identify next steps for ensuring an adequate

nurse supply

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Implications for policy

  • How do we define shortage?

– Are current employment levels adequate? – Should California be at the national average? 25th percentile? Bottom? – Economic demand vs. need-based demand

  • In this economy…

– Demand is starting to ramp up again

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Concerns for workforce policy

  • If RN education contracts, our supply will fall far

short of demand

  • Will recent graduates who can’t find work leave

California permanently?

  • Can we foster opportunities to gain on-the-job

skills and to pursue additional education?

  • What do we need to do?

– Stop the expected declines in RN school sizes – Consider growing our RN programs a bit more – Identify strategies to retain new graduates’ skills and employ them quickly

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Check out our website!

  • http://futurehealth.ucsf.edu/SupplyDemand/Das

hboard.html

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Also go to the BRN website

  • Forms  Publications

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Available from the BRN website

  • Annual Schools Report

– Public-use Excel workbook to summarize data by region, type of program…

  • RN Surveys (every 2 years)

– Full reports – Link to a webpage with summary data, and ability to get regional and other cuts of the data

  • RN Forecasts

– Full reports – Regional reports when we have them

  • Other studies

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What is happening next?

  • UCSF and HASC are continuing our

collaboration

– HASC does quarterly surveys of HR directors – UCSF does annual CNO surveys

  • The 2012 BRN Survey of RNs report will be

published soon

  • The 2012-2013 BRN Annual Schools Survey will

be sent in October

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Questions?

Thoughts? Ideas? Perspectives?

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