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

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 4

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? 5

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 7

Perceptions of employers: Overall labor market Fall 2014 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2014 18.4% 49.0% 13.1% 12.6% 6.8% 2013 8.6% 32.3% 18.7% 26.8% 13.6% 2012 5.5% 45.2% 19.8% 17.1% 12.4% 2011 4.7% 43.9% 6.8% 23.6% 20.9% 2010 5.3% 30.9% 11.8% 27.0% 25.0% 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 S. Border 3.3 Inland Empire 3.6 LA Central CA SF Bay 3.1 3.8 3.7 2014 2013 2012 2011 2010 Sacramento & North 3.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 9

Differences across regions: Experienced RNs S. Border 3.70 Inland Empire 4.14 LA Central CA 4.17 4.21 2014 2013 SF Bay 3.79 Sacramento & North 4.17 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 10

Differences across regions: New Grad RNs S. Border 1.60 Inland Empire 1.95 LA Central CA 1.68 1.97 2014 2013 SF Bay 1.42 Sacramento & North 2.33 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 11

Rural vs. urban perceptions 5 4.5 4 3.5 3 2.5 2 4.13 3.50 2010 2011 2012 2013 2014 1.5 1 Rural Non-Rural 12 Higher number = more shortage

Difficulty recruiting, compared to last year, Fall 2014 CNS 26.9% 71.4% 1.7% CRNA 7.8% 78.4% 13.8% CNM 2.1% 96.8% 1.1% NP 16.1% 70.8% 13.1% Aide/Asst 12.5% 66.1% 21.4% LVN 2.9% 30.7% 66.4% Other RN 40.9% 54.1% 5.0% Staff RN 25.0% 66.0% 9.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% More difficult No change Less difficult 13

Change in employment in the past year (2013-2014) CNS 10.8% 83.5% 5.7% CRNA 12.2% 74.4% 13.4% CNM 4.0% 90.1% 6.0% NP 36.7% 51.7% 11.7% Aide/assistant 26.5% 59.7% 13.7% LVN 7.4% 44.1% 48.5% Other RN 28.4% 63.9% 7.7% Staff RN 51.2% 44.1% 4.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Increased employment No change Decreased employment 14

Change in RN hiring by care setting (2013-2014) Long-term care 8.0% 85.8% 6.2% Home health 14.8% 71.1% 14.1% Ambulatory care 33.9% 61.3% 4.8% Inpatient care 49.8% 44.2% 6.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Increased employment No change Decreased employment 15

Hiring requirements and preferences, 2011-2014 No specific requirements Baccalaureate degree preferred Baccalaureate degree required Minimum experience requirement 14.9% 21.2% 9.8% 4.6% 70.7% 69.5% 60.5% 52.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 2014 2013 2012 2011 16

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 17

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 18

Overall hiring expectations for the next year 100% 8.7% 18.6% 17.2% 14.9% 4.2% 75% 48.1% 50% 50.0% 67.8% 51.6% 50.0% Hire fewer than last year 25% 0% 31.4% 23.5% 31.2% 35.1% 47.7% No change Hire more than last year Reasons for expected growth: Expected increase in census, Expected increase in acuity 19

Expected RN hiring by care setting for next year (2014-2015) Long-term care 9.7% 78.6% 11.7% Home health 31.9% 65.5% 2.7% Ambulatory care 42.3% 57.1% 0.6% Inpatient care 43.3% 52.1% 4.7% 0% 20% 40% 60% 80% 100% Increased hiring No change Decreased hiring 20

Hiring of newly graduated RNs, 2010-2014 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 8.7% 8.0% 9.8% 16.1% 10.6% 6.7% 9.4% 12.6% 6.5% 7.8% 84.6% 82.6% 77.6% 76.0% 82.9% 2010 2011 2012 2013 2014 Do not hire ever Normally hire, but not this year Hired this year 21

Percent of new hires that were new graduates 40% 35% 30% 25% 20% 15% 10% 5% 0% Fall 2012 Fall 2013 Fall 2014 34.0% 32.0% 31.0% 29.0% 26.0% 24.0% 15.0% 6.0% 7.0% Full-time Part-time Overall 22

Hiring of new graduates into non-rn roles 50% 40% 30% 28.6% 31.7% 20% Hire into non-rn roles 10% 0% 2013 2014 23

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% 24

Residency programs for non-employee new graduates, Fall 2014 Ambulatory care Pediatrics/neonatal OR/peri-op Obstetrics/newborn Critical care Emergency Medical-surgical 0% 20% 40% 60% 80% 100% 25

Hiring expectations for new graduates 2014-2015 100% 18.7% 22.3% 14.8% 7.7% 75% 57.2% 50% 59.7% 55.4% 61.1% Decrease hiring No change Increase hiring 25% 0% 21.6% 22.3% 24.1% 35.1% 2011-2012 2012-2013 2013-2014 2014-2015 26

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 27 Presentation Title and/or Sub Brand Name Here 4/28/15

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 29 Presentation Title and/or Sub Brand Name Here 4/28/15

Quarterly turnover of full-time personnel, Fall 2013 vs. Fall 2014 4.0% 3.5% 3.0% 2.5% 2.3% 2.6% 3.4% 2.9% 3.1% 3.7% 2.8% 2.5% 2.0% 1.5% 2013 2014 1.0% 0.5% 0.0% Staff RNs Other RNs LVNs Aides 30

Quarterly hiring of full-time personnel, Fall 2013 vs. Fall 2014 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 4.5% 3.9% 3.5% 3.6% 2.7% 2.5% 2.5% 2.3% Staff RNs Other RNs LVNs Aides 2013 2014 31

RN Vacancies, 2010-2014 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 3.4% 4.0% 3.7% 4.2% 4.6% Fall 2010 Fall 2011 Fall 2012 Fall 2013 Fall 2014 0.5% 0.0% All RNs 32

Vacancy rates by part-time and full-time status, Fall 2014 14% 12% 11.7% 10% 8% 6% 4% 5.3% 3.5% 6.1% 5.2% 5.4% 4.1% 3.5% 4.7% 5.0% Full-time Part-time 2% 0% Staff RNs Other RNs New RN Grads LVNs Aides 33

Per Diem, Contract, and Agency RN Staff as Percent of Current Staff 16% 14% 12% 10% 8% 6% 4% 2% 0% 2010 2011 2012 2013 2014 Per Diem Contract Agency 34

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 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 6,158 11,291 37

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 70% 60% 50% 40% 30% 20% 10% 0% Percent of new graduates employed in nursing Fall 2010 Fall 2011 Fall 2012 Fall 2013 Fall 2014 39

Regional variation in employment Central Coast Sacramento Central Valley San Diego/ Imperial N CA Orange/Inland SF Bay LA/Ventura 50% 56% 55% 63% 62% 66% 69% 87% Working as RN 2012 Working as RN 2013 Working as RN 2014 0% 20% 40% 60% 80% 100% 40

Employment rate varies by education 80% 70% 60% 53% 55% 62% 55% 63% 70% 59% 67% 58% 50% 40% 2012 2013 30% 2014 20% 10% 0% AD BSN ELM 41

Employment settings of new graduates 80.0% 72% 70.0% 59% 60.0% 2013 2014 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 13% 8% 5% 4% 4% 5% 2% 2% 2% 0% 15% 9% 42

For those employed 55.7% employed within 3 months 46.6% in the 2013 survey 70.2% reported working in job of choice 61.6% in the 2013 survey 79.4% are working full time 77.2% in the 2013 survey 21.3% participated in a transition to practice or residency program 26.6% in the 2013 survey 43

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? 40% 30% 20% 10% 23.0% 19.7% 20.2% 18.2% 20.5% 15.5% 12.7% 8.2% 33.6% 28.6% 0% 2013 2014 45

What do Deans & Directors observe? Deans estimates of the percent of grads from the past year in each employment setting 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 Employed in CA 5.4% 3.9% 4.5% 3.6% 3.6% 3.7% 83.4% 81.1% 68.0% 69.6% 72.9% 68.8% 46

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? 49

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 50

Check out our website! http://rnworkforce.ucsf.edu 57

57 Interactive data displays

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 54

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 55

Questions? Thoughts? Ideas? Perspectives? 56