Policy, Politics, and the Reality of Health Workforce Planning
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1 Policy, Politics, and the Reality of Health Workforce Planning Joanne Spetz University of California, San Francisco Center for California Health Workforce Studies & School of Nursing June 2007
2 How is nursing workforce planning really done? Term-limited or entrenched legislature Lack of research and knowledge Influence of interest groups Lack of money But sometimes policy inadvertently gets it right!
3 Term limits or entrenchment? Term-limited legislatures Do not have expert members who understand nursing or health workforce Rely heavily on staffers, who stay there longer than any legislator Lose power to the Governor Entrenched legislatures Have experts, but also have strong opinions Particular members can have undue influence Have more power over the Governor and staff
4 What have term limits done in California s planning? Figure 6. Projected Shortage of Registered Nurses (FTEs) in California, , , , , , , ,000 50, Year Supply Forecast DOL-based Demand Forecast Budgeted Position-based Demand Forecast BHPr Demand Forecast OSHPD HPPD-based Demand Forecast
5 Lack of research and knowledge Nobody knows what future population needs will be Holy Grail of the best mix of health workforce has not been found If there is a better model, we haven t seen it yet The ideal model is hard to explain to policymakers They have trouble with understanding the current state of affairs
6 Knowledge in California Reports on the nursing shortage Center for the Health Professions 2000 California Strategic Planning Committee on Nursing, multiple reports Board of Registered Nursing, 2005 California Institute on Nursing and Health Care, 2006 Center for California Health Workforce Studies, 2006 Legislative Analyst s Office, 2007
7 Interest group politics California Hospital Association Focuses on the nursing shortage Wants to eliminate minimum nursing ratio laws Wants the state government to pay for more education California s nursing unions California Nurses Association has denied a shortage to protect minimum staffing ratio laws Service Employees International Union at odds with Cal Nurses, in partnership with Kaiser Permanente
8
9 More interest groups! Nurse professional organizations Association of California Nurse Leaders Nursing advocacy group California Institute on Nursing and Health Care Insurance companies Mexican-American Legal Defense and Education Fund (MALDEF) University and college Chancellors Offices
10
11 Funding drives policy State budget crises California legislature passes programs, but cannot fund them Competition for federal grants Workforce Investment Act Employment Development Department has had money to spend, but do they have expertise? Private Foundations Gordon & Betty Moore Foundation in Bay Area Hospitals Grants to education programs Contract education
12 An example of funding driving policy California Nurse Workforce Initiative (NWI), launched 2002 Workforce Investment Act money granted to Workforce Investment Boards WIBs are rated on how many students they graduate in a time period, and earnings increases No incentive to invest in long-term programs
13 What happened with NWI? 21 of 22 grantees were WIBs Money mostly used to support currently enrolled students Some WIBs had to pay for contract education to enroll their students in programs High share of LVN students enrolled Maybe this was a good thing? Graduation rates improved for supported students Cost per new nurse was higher than if they had expanded nursing education programs
14 The battle of nursing programs Nursing programs that offer graduate education do not always focus on long-term population needs Surfeit of Nurse Practitioners Lack of Educators The ongoing AD vs. BSN debate Focus on primary nursing education ignores lifelong educational needs
15 Sometimes policymakers accidentally get it right NWI s LVN graduates have helped nursing homes NWI s student support included counseling & case management, which helped retention Hospital-education partnerships have been successful Some health care providers are innovating Pay for performance might change everything
16
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