The End of the Shortage? Emerging Trends in California’s ... · Emerging Trends in California’s...

The End of the Shortage? Emerging Trends in California’s RN Labor Market

April 28, 2015

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

2

Goals for this webinar

§ Assess how the economic recovery is affecting demand for RNs in California

•  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

§ Identify next steps for ensuring an adequate nurse supply

3

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

•  FutureSense Inc.

•  Hospital Association of San Diego & Imperial Counties

•  UCSF Staff & Interns: Tim Bates, Lela Chu, Jesse Smith

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What is going on in our RN labor market?

§ Reports of nurse surplus 2009-now

•  Newspaper stories of new graduates who are unemployed

•  Shortage may not have ended in some states

§ Emerging reports of shortage

•  Anecdotes about using more contract nurses

•  Potential mismatch between needs and skills

§ What will happen next?

•  Is the economic recovery changing the situation?

•  Is the Affordable Care Act changing the situation?

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6

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

§ 7 surveys conducted

•  Fall 2010, Spring 2011, Fall 2011, Spring 2012, Fall 2012, Fall 2013, Fall 2014

•  Fall 2014 survey: 207 CNO responses, 238 HR Director responses

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Perceptions of employers: Overall labor market Fall 2014

18.4%

8.6%

5.5%

4.7%

5.3%

49.0%

32.3%

45.2%

43.9%

30.9%

13.1%

18.7%

19.8%

6.8%

11.8%

12.6%

26.8%

17.1%

23.6%

27.0%

6.8%

13.6%

12.4%

20.9%

25.0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2014

2013

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

8

Differences across regions: Overall RN labor market

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3.5

3.1

3.7

3.8

3.6

3.3

1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Sacramento & North

SF Bay

Central CA

LA

Inland Empire

S. Border

2014 2013 2012 2011 2010

Differences across regions: Experienced RNs

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4.17

3.79

4.21

4.17

4.14

3.70

1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00

Sacramento & North

SF Bay

Central CA

LA

Inland Empire

S. Border

2014 2013

Differences across regions: New Grad RNs

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2.33

1.42

1.97

1.68

1.95

1.60

1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00

Sacramento & North

SF Bay

Central CA

LA

Inland Empire

S. Border

2014 2013

Rural vs. urban perceptions

4.13

3.50

1

1.5

2

2.5

3

3.5

4

4.5

5

Rural Non-Rural

2010 2011 2012 2013 2014

12 Higher number = more shortage

Difficulty recruiting, compared to last year, Fall 2014

25.0%

40.9%

2.9%

12.5%

16.1%

2.1%

7.8%

26.9%

66.0%

54.1%

30.7%

66.1%

70.8%

96.8%

78.4%

71.4%

9.0%

5.0%

66.4%

21.4%

13.1%

1.1%

13.8%

1.7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Staff RN

Other RN

LVN

Aide/Asst

NP

CNM

CRNA

CNS

More difficult No change Less difficult

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Change in employment in the past year (2013-2014)

51.2%

28.4%

7.4%

26.5%

36.7%

4.0%

12.2%

10.8%

44.1%

63.9%

44.1%

59.7%

51.7%

90.1%

74.4%

83.5%

4.7%

7.7%

48.5%

13.7%

11.7%

6.0%

13.4%

5.7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Staff RN

Other RN

LVN

Aide/assistant

NP

CNM

CRNA

CNS

Increased employment No change Decreased employment

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Change in RN hiring by care setting (2013-2014)

49.8%

33.9%

14.8%

8.0%

44.2%

61.3%

71.1%

85.8%

6.0%

4.8%

14.1%

6.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Inpatient care

Ambulatory care

Home health

Long-term care

Increased employment No change Decreased employment

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Hiring requirements and preferences, 2011-2014

52.3%

4.6%

69.5%

21.2%

60.5%

9.8%

70.7%

14.9%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Minimum experience requirement

Baccalaureate degree required

Baccalaureate degree preferred

No specific requirements

2014 2013 2012 2011

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Plans regarding BSN-educated nurses, 2014

§ 71% plan to increase the share with BSN (was 66% in 2013)

•  54% are targeting more than 50%

§ 11.8% require that hired RNs obtain a BSN within a certain time

§ 55.1% require a BSN for promotion beyond staff nurse

§ 32.9% differentiate RN salary by education degree

•  48.4% differentiate RN salary by advanced certification

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Challenges to increasing the share of BSN-educated RNs

§ Most common barriers to increasing share with BSN:

•  Low supply of BSN-educated RNs in community

•  Lack of tuition reimbursement funds

•  Lack of funds for financial incentives

•  Lack of interest among RNs

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Overall hiring expectations for the next year

31.4% 23.5% 31.2% 35.1% 47.7%

50.0% 67.8% 51.6% 50.0%

48.1%

18.6% 8.7% 17.2% 14.9% 4.2%

0%

25%

50%

75%

100%

Hire fewer than last year

No change

Hire more than last year

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Reasons for expected growth: Expected increase in census, Expected increase in acuity

Expected RN hiring by care setting for next year (2014-2015)

43.3%

42.3%

31.9%

9.7%

52.1%

57.1%

65.5%

78.6%

4.7%

0.6%

2.7%

11.7%

0% 20% 40% 60% 80% 100%

Inpatient care

Ambulatory care

Home health

Long-term care

Increased hiring No change Decreased hiring

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Hiring of newly graduated RNs, 2010-2014

84.6% 82.6% 77.6% 76.0% 82.9%

6.7% 9.4% 12.6% 7.8% 6.5%

8.7% 8.0% 9.8% 16.1% 10.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

2010 2011 2012 2013 2014

Do not hire ever

Normally hire, but not this year

Hired this year

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Percent of new hires that were new graduates

34.0%

6.0%

26.0%

32.0%

15.0%

31.0% 29.0%

7.0%

24.0%

0% 5%

10% 15% 20% 25% 30% 35% 40%

Full-time Part-time Overall

Fall 2012 Fall 2013 Fall 2014

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Hiring of new graduates into non-RN roles

28.6% 31.7%

0%

10%

20%

30%

40%

50%

2013 2014

Hire into non-RN roles

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Residency programs for non-employee new graduates, Fall 2014

§ 39 hospitals have residencies for new graduates not guaranteed to be hired

•  Most common capacity is 20-30 new grads

•  Most common length is 12-16 weeks

•  63.2% internally-developed

•  68.3% paid program

§ 77.1% of hospitals said 75-100% of residency completers were hired in last year

•  14.3% said they hired less than 25%

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Residency programs for non-employee new graduates, Fall 2014

0% 20% 40% 60% 80% 100%

Medical-surgical

Emergency

Critical care

Obstetrics/newborn

OR/peri-op

Pediatrics/neonatal

Ambulatory care

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Hiring expectations for new graduates 2014-2015

21.6% 22.3% 24.1% 35.1%

59.7% 55.4% 61.1%

57.2%

18.7% 22.3% 14.8% 7.7%

0%

25%

50%

75%

100%

2011-2012 2012-2013 2013-2014 2014-2015

Decrease hiring No change Increase hiring

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Reasons for expected changes in new graduate hiring § Expect an increase

•  Fewer experienced RNs will be available

•  Partnerships with academic programs to create pipelines

•  Expansion of own clinical programs

§ Expect a decrease

•  Too many new graduates already

•  Cost of transitioning new graduates too high

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Hospital Association of Southern California’s Healthcare Workforce Survey

§ Fielded quarterly by the Hospital Association of Southern California and FutureSense Inc.

§ Conducted via online survey sent to HR Directors

§ Data collected over a period of one month in September 2014

§ Data describes staffing, turnover, and hiring patterns for third quarter of the year (July – September 31, 2014)

§ Elicited 193 unique responses, representing 238 general acute care hospitals, and 51,530 beds

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Quarterly turnover of full-time personnel, Fall 2013 vs. Fall 2014

2.3%

3.4% 3.1%

2.8% 2.6%

2.9%

3.7%

2.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Staff RNs Other RNs LVNs Aides

2013 2014

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Quarterly hiring of full-time personnel, Fall 2013 vs. Fall 2014

3.5%

2.5% 2.5%

3.9%

4.5%

2.3% 2.7%

3.6%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

Staff RNs Other RNs LVNs Aides

2013 2014

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RN Vacancies, 2010-2014

3.4%

4.0% 3.7%

4.2% 4.6%

0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 5.0%

All RNs

Fall 2010 Fall 2011 Fall 2012 Fall 2013 Fall 2014

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Vacancy rates by part-time and full-time status, Fall 2014

5.3% 6.1%

5.4% 4.1% 4.7%

3.5%

5.2%

11.7%

3.5% 5.0%

0%

2%

4%

6%

8%

10%

12%

14%

Staff RNs Other RNs New RN Grads

LVNs Aides

Full-time Part-time

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Per Diem, Contract, and Agency RN Staff as Percent of Current Staff

0%

2%

4%

6%

8%

10%

12%

14%

16%

2010 2011 2012 2013 2014

Per Diem

Contract

Agency

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35

New RN Graduate Hiring Survey

§ Statewide survey of new grads conducted in fall of 2014

§ Collaborators:

•  CINHC

•  UCLA School of Nursing

•  California Board of Registered Nursing

•  Association of California Nurse Leaders

•  California Student Nurses Association

§ Funder:

•  Kaiser Permanente Fund for Health Education at the East Bay Community Foundation

36

California RN graduations per year

6,158

11,291

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

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New RN Graduate Hiring Survey

§ Random selection of 3,429 newly licensed RNs in CA - September 2013 through August 2014

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

§ 634 responses received (18.5% response rate)

§ Margin of error is +/- 3.8 percentage points

38

Findings from the 2014 New RN Graduate Hiring Survey

0%

10%

20%

30%

40%

50%

60%

70%

Fall 2010 Fall 2011 Fall 2012 Fall 2013 Fall 2014

Percent of new graduates employed in nursing

39

Regional variation in employment

40

69%

55%

66%

62%

50%

87%

56%

63%

0% 20% 40% 60% 80% 100%

LA/Ventura

SF Bay

Orange/Inland

N CA

San Diego/Imperial

Central Valley

Sacramento

Central Coast

Working as RN 2012

Working as RN 2013

Working as RN 2014

Employment rate varies by education

41

53% 55% 59%

55%

63% 67%

62%

70%

58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

AD BSN ELM

2012 2013 2014

Employment settings of new graduates

42

59%

13% 5% 4% 2% 2%

15%

72%

8% 4% 5% 2% 0%

9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

2013 2014

For those employed…

§ 55.7% employed within 3 months

•  46.6% in the 2013 survey

§ 70.2% reported working in “job of choice”


§ 79.4% are working full time


§ 21.3% participated in a transition to practice or residency program


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Why are they not employed?

§ 83.3% no experience

§ 41.3% no position available

§ 38.5% BSN preferred or required

§ 21.8% work experience not applicable

§ 4.5% academic preparation insufficient for position scope

§ 4.3% weak resume related to volunteering or activity to enhance experience/skills

§ 2.3% out of school too long

§ 0.8% low GPA

44

What are unemployed nurses doing?

23.0% 20.2% 15.5% 12.7%

28.6%

19.7% 18.2% 20.5%

8.2%

33.6%

0%

10%

20%

30%

40%

2013 2014

45

What do Deans & Directors observe?

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

Hospital 71.4% 59.0% 54.4% 61.1% 56.7% 56.0%

Long-term care 8.4% 9.7% 7.8% 8.3% 7.9% 7.1%

Comm/public health

5.4% 3.9% 4.5% 3.6% 3.6% 3.7%

Employed in CA

83.4% 81.1% 68.0% 69.6% 72.9% 68.8%

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

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47

What is happening now?

§ There is current and anticipated job growth

•  Inpatient care growth in census and higher acuity

•  Ambulatory care growth

§ Shortages are emerging

•  Experienced RNs are in short supply

‒ Operating Room

‒ Labor & Delivery

‒ Emergency Department

‒  Intensive care

§ Reservoir of recent graduates who are still unemployed

48

Concerns for workforce policy

§ Will recent graduates who can’t find work leave California permanently?

§ What education changes are needed to ensure new graduates have the right skills?

§ Can we foster opportunities to gain on-the-job skills and to pursue additional education?

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Some recommendations § Employers: Invest in new graduate hiring

•  Less expensive than a shortage

‒ Recruitment costs

‒ Costs of patient care lapses

‒ Costs of rapid wage increases

§  Educators: Partner with employers

•  Offer electives in the clinical areas of shortage

•  Ensure streamlined education progression

§ Policymakers: Maintain education capacity

•  Do not let enrollments drop

•  Support scholarship programs such as the HPEF programs

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Check out our website! http://rnworkforce.ucsf.edu

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Interactive data displays

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Also go to the BRN website Forms è Publications

53

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 2014 BRN Survey of RNs report will be published later this spring or early summer

•  New forecasts in Summer 2015

§ The 2014-2015 BRN Annual Schools Survey will be sent in October

§ The 2015 Employer Survey will be sent in October

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Questions?

Thoughts?

Ideas?

Perspectives?

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