Long-term Care Nursing Workforce in Wyoming LABOR HEALTH AND SOCIAL SERVICES COMMITTEE OCTOBER 2017 The Wyoming Center For Nursing
Wyoming Center for Nursing The Wyoming Center for Nursing is committed to creating a culture of health that promotes the development of a diverse health care workforce by transforming nursing education, advancing the health of individuals, and improving communities through fostering collaborative partnerships. Major Projects ReNEW Nurses on Boards Nursing Workforce Diversity Long-term Care Nursing Workforce Partners Employers Educational programs State agencies Foundations Professional organizations
WCN Project: Recruitment and Retention Nursing Workforce in Long-term Care Literature Review re: Recruitment and Retention in LTC Informal Interviews with LTC Administrators in Wyoming Search for Available Data on Nursing Workforce in Wyoming Wyoming State Board of Nursing (WSBN) Wyoming Department of Health (WDH) Wyoming Department Workforce Services (DWS)
What is Long-Term Care? Long-term care provides a variety of services, both medical and personal care, to people who are unable to manage independently in the community. Long Term Care Facility (LTCF): A facility that provides rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living. Nursing homes Skilled nursing facilities Assisted living facilities Home health care (https://www.cdc.gov/longtermcare/index.html)
Long-term Care in Wyoming Numbers of facilities 38 Nursing Homes 25 Not-for-profit 13 For Profit 47 Home Health Agencies 32 Assisted Living Centers
Long-term Care Needs in Wyoming
LTC Nursing Workforce by Type (WSBN, 2017) * Education CNA Certified Nursing Assistant CNA 2 Certified Nursing Assistant 75 + hours Work 1 year as CNA then additional training. Minimum 30 hours MA-C Medication Assistant Certified* Must be CNA II MA-C course shall be a minimum of 100 hours. 60 hours of classroom instruction and 40 hours of supervised clinical practice then exam LPN Licensed Practical Nurse 1+ year college National exam RN Registered Nurse 2 years ADN 4 Years BSN National Exam APRN Advanced Practice Registered Nurse BSN + 2-3 years graduate school either and DNP. Credential Certificate Certificate Certificate License License License Number in State 6077 245 74 1150 12778 754 Number working in LTC Unknown but probably high percentage Unknown but probably most Unknown but probably most Unknown, but probably most Unknown, but probably low percentage Unknown, but probably very low percentage *MA-C should NOT be confused with a Medical Assistant (MA). MA s are not regulated in the state of Wyoming. There is no education standardization with this level of healthcare provider and they generally work in doctors offices and some clinics. They are not typically used in long term or acute care facilities.
Certified Nursing Assistants 7134 listed on the Dept. of Health Registry as of 9-6-17 6077 with active Certificate 245 - CNA II 74 Medication Assistant-Certified (MA-C) CNA education and testing problems in Wyoming. 68 approved CNA programs.
Literature Review: Themes LTC Nursing Workforce CNA, LPN, RN and APRN Numbers Characteristics Challenges (main focus on nursing homes) Recruitment and retention Increased demands due to aging population Preparation Factors Related to Recruitment and Retention Administrative climate and support Communication Workplace effectiveness Nursing home ownership Job satisfaction Salary and benefits Contingency factors, i.e., shocks Participation in facility governance Resource adequacy Demographics, e.g., race/ethnicity
Literature Review: Themes (Cont.) Quality in LTC: Outcomes Deficiencies, UTIs, pressure ulcers Staffing characteristics: Turnover, staffing levels, worker stability/tenure, use of agency staff RN and Total Nursing Hours CNA Hours State minimum staffing levels Nursing practice environment Ownership RN retention rate/tenure Recommendations Models of Care Educational Initiatives Increase use of RNs Increase use of APRNs
Informal Interviews: Themes Regulations Turnover Continuing Education Emphasis on caring for residents with Dementia Management of mandatory educational requirements Generational Workforce Issues Medicare/Medicaid reimbursement always an issue
WY Department of Workforce Services Study (2017): Major Findings Relevant to LTC Findings related to nursing and nursing shortage relevant to LTC and most likely exacerbated in LTC. Aging of Wyoming s health care workforce. Less than 50% UW and WY community colleges graduates with healthcare-related degrees are working in WY 8 years after graduation. Rural/urban differences. Supply and demand differences across state.
WY Department of Workforce Services Study (2017): Findings related to CNAs Overall age of CNAs decreased from 2010 to 2015 Length of job tenure shorter in CNAs (3.5 yrs) compared to RNs (~6 yrs) 2010 Cohort of 5833 CNAs with certificate in WY 50.5% enrolled in post-secondary education at UW or WY community college 8.7% earned associate degree 4.1% earned baccalaureate degree Those who obtained a degree had increased salary after having a drop in salary. See next slide By 2015, 70% of 2010 cohort took a different career path. Almost 10% became RNs or LPNs, but other career paths. See next slide
Conclusions Needs for LTC in Wyoming will only increase and LTC is in a turbulent heavily regulated environment. Lots of factors impact recruitment and retention of LTC nursing workforce. Quality of care in LTC impacted by recruitment and retention of LTC nursing workforce. Make up of LTC nursing workforce in Wyoming is not definitely known; nor are specific factors that impact recruitment and retention. Significant churn of CNA workforce exists in Wyoming. Workplace injuries/violence..
Recommendations Study to determine the composition and factors impacting recruitment and retention of the LTC nursing workforce in Wyoming. Most recent DWS on vacancies and recruitment and retention of nurses, including those in LTC, was in 2008. Explore and support models of care that enhance recruitment and retention of nurses in LTC Coordinated, collaborative efforts to stabilize supply of CNAs. Stronger voice and presence from LTC nurses, e.g., WSBN, WCN advisory board