Strengths of the Nursing Workforce and Challenges Nurses and the Health Organiza9ons that Employ them will Face Over the Next 10 Years

Strengths of the Nursing Workforce and Challenges Nurses and the Health Organiza9ons that Employ them will Face Over the Next 10 Years The Missouri Hospital Associa9on June 15, 2017 Peter I. Buerhaus PhD, RN, FAAN, FAANP(h) Professor of Nursing, and Director Center for Interdisciplinary Health Workforce Studies College of Nursing, Montana State University

Big Picture: It s the Right Time and a Good Time to Reset Strategic Rela9onships 1. With nurses, physicians, community and organiza9on 2. To ensure an adequately sized, well- configured, and well prepared nursing workforce 3. Capable of mee9ng challenges that lie ahead

Overview 1. Strengths of the nursing workforce 2. Challenges facing the nursing workforce over the next 10 years 3. Implica9ons for leadership and strategic ac9ons

Research Program Four Interdisciplinary teams 1. Economic issues: RN employment, earnings, effects of health reforms, forecas9ng nurse and physician supply Doug Staiger, Dartmouth College & Na9onal Bureau Economic Research Dave Auerbach, Boston, Mass Health Reform Commission John Graves, Vanderbilt University 2. Survey research: percep9ons of various popula9ons about RNs and changes in health care, etc. Karen Donelan, Harvard and Massachusebs General Hospital Catherine DesRoches, Harvard 3. Assessing contribu9ons of nurse prac99oners: Quan99es, types, costs, & quality of NP services Jennifer Perilous and Monica O Reilly Jacob, Brandeis University Karen Donelan and Catherine DesRoches, Harvard Sean Clarke, Boston College Robert Dibus, MD, Vanderbilt University Medical Center 4. Quality of care: Construc9ng, tes9ng & refining quality of care measures associated with nurses Jack Needleman, UCLA

Disclosure Studies that provide informa9on for presenta9on funded by: Gordon & Beby Moore Founda9on Robert Wood Johnson Founda9on State Health Access Reform Evalua9on (SHARE), an RWJF Na9onal Program American Associa9on of Nurse Prac99oners

Disclosure The data and views expressed in this presenta9on are mine, and are not the views of the (s9ll unfunded) Na9onal Health Care Workforce Commission established in 2010! Buerhaus, P. Retchin, S. The Dormant Na9onal Health Care Workforce Commission Needs Congressional Funding To Realize its Promise. Heath Affairs (November 2013).

1. Strengths of the Nursing workforce (2000-2015) From the Nursing Profession s Perspec9ve 1. Increasing educa9on, steady employment growth, RN compensa9on beber than most 2. Hospitals have linked value to BSN prepared RNs 3. Increasing numbers of RNs through 2030, enough to replace re9rement of baby boom RNs 4. Increasing evidence of posi9ve contribu9ons of primary care nurse prac99oners 5. Strong public percep9ons of nursing, increasing influence in health policy

Drama9c growth in RN graduates 2002- Present Number of new RN graduates more than doubled from 77,000 in 2002 to over 200,000 in 2014 Broad based, rapid growth among All demographic groups (Men, Hispanics, African Americans) In baccalaureate and associate degree programs In private and public ins9tu9ons And especially in private for- profit schools Buerhaus, P, Auerbach, D., Staiger. D. The rapid growth of graduates from associate, baccalaureate and graduate programs in nursing. Nursing Economic$. 32(6), 290-295, 311.

Degrees Awarded in Associate and Baccalaureate Nursing Educa9on Programs, 1984-2015 140,000 120,000 100,000 Total Degrees Awarded 80,000 60,000 40,000 20,000 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Associates degree Baccalaureate degree

Masters and Doctoral Degrees Awarded, 1984-2015 45,000 40,000 35,000 30,000 Total Degrees Awarded 25,000 20,000 15,000 10,000 5,000 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Total Full- Time Equivalent (FTE) RN Employment Growth by Major Employment Sekng, 2001-2015 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 Total FTE RNs Hospital 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Hospitals have linked value to BSN prepared RNs 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 ADN-Hospital BSN-Hospital ADN-Non-hospital BSN-Non-hospital

Strong public percep9ons of nursing Americans Admire, Trust, and Respect Nurses above all Other Professions Assure quality of care Protec9on and safety Advice on personal health issue

How important are nurses to health services? Assuring overall quality 82 16 20 Slowing growth of health costs 46 39 14 1 Assuring access 50 36 13 1 Assuring safety 89 9 20 0 20 40 60 80 100 Very Important Not very/not at all important Somewhat important don t know Donelan, Buerhaus, DesRoches, Burke,(2010). Health Policy Thoughtleaders Views of the Health Workforce in an Era of Health Reform. Nursing Outlook. 58(4): 175-180.

Increasing evidence of posi9ve contribu9ons of primary care nurse prac99oners (PCNPs)

Congressional Concerns and Ques9ons 1. Access to primary care Physician shortages Uneven distribu9on of physicians Willingness to accept Medicaid pa9ents Do state level regulatory restric9ons placed on nurse prac99oners limit access to primary care? 2. Cost and quality Are nurse prac99oners lower cost subs9tutes to physicians? How does NP quality compare to physicians?

Research program on access and quality of care provided by primary care nurse prac99oners (PCNPs) and physicians (PCMDs) Studies focus on: 1. Primary care physician loca9on Influence of highly educated spouse Power Couples Geography of primary care workforce 2. Comparing PCNPs and PCMDs on types, quan99es, costs and quality of services Studies using na9onal Medicare data (2008-2013) 2012 na9onal surveys of PCNPs and PCMDs

Results of physician loca9on studies The propor9on of physicians married to highly educated spouses has grown drama9cally, from <10% in 1960 to nearly 60% in 2010 1 These physicians are significantly less likely (40%) to prackce in a rural health professional shortage areas 1 Rural areas have highest uninsured popula9ons and least access to primary care 2 PCMDs are more likely to prac9ce in large metropolitan and urban areas PCNPs, though fewer than PCMDs, are more likely to prackce in rural areas 1 Staiger, D., Marshall, S., Goodman, D., Auerbach, D., Buerhaus, P. (March 1, 2016). Associa9on between having a highly educated spouse and physician prac9ce in rural underserved areas. The Journal of the American Medical AssociaKon. 315(9:939-942. 2 Graves, J., Mishra, P., Dibus, R., Parikh, R., Buerhaus, P. (2016). Role of Geography and Nurse Prac99oner Scope- of- Prac9ce In Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Medical Care. 54(1): 81-89

People living in states that restrict the prac9ce of NPs have less access to primary care (2014) 2 2 Graves, J., Mishra, P., Dibus, R., Parikh, R., Buerhaus, P. (2016). Role of Geography and Nurse Prac99oner Scope- of- Prac9ce In Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Medical Care. 54(1): 81-89.

Results of studies comparing Primary Care Nurse Prac99oners and Physicians Medicare Data (2008 2013) and 2012 Na9onal Survey of PCNPs and PCMDs PCNPs are significantly more likely than PCMDs to provide primary care to vulnerable Medicare beneficiaries and to accept those on Medicaid 2-5,6,8,9 Women, non- whites, American Indians, disabled, poor, dual eligibles, those on Medicaid & people who do not speak English as first language The types of services provided by PCNPs and PCMDs are very similar 4 PCNPs cost Medicare significantly less than PCMDs (11% - 30%) for providing the same services, even arer accoun9ng for PCNP lower payment rate 6 PCNPs use fewer and less expensive resources 7

Results Con t Medicare Data (2008 2013) and 2012 Na9onal Survey of PCNPs and PCMDs Beneficiaries treated by PCNPs receive beber quality of care than those treated by PCMDs as measured by lower: U9liza9on of services (hospitaliza9ons, readmissions, ED use, and MRIs for low back pain) 8 Beneficiaries treated by PCMDs receive beber quality of care than those treated by PCNPs as measured by greater Chronic disease management and cancer screening 8 Beneficiaries treated by PCNPs have protec9ve effect on disabled and dual eligibles 9 State- level Scope of Prac9ce regula9ons placed on NPs are not associated with the quality of primary care received by Medicare beneficiaries 10

2012 na9onal survey of Primary care Physicians and Nurse Prac99oners Would increasing the number of NPs in primary care NPs MDs Decrease MD income 24% 57% Increase replacement of MDs with NPs 53 75 3 Donelan, K., DesRoches, C., Dibus, R., Buerhaus, P. (May 16, 2013) Perspec9ves of physicians and nurse prac99oners on primary care prac9ce. The New England Journal of Medicine 368(20):1898-1906.

Published Studies to Date 1. Staiger, D., Marshall, S., Goodman, D., Auerbach, D., Buerhaus, P. (March 1, 2016). Associa9on between having a highly educated spouse and physician prac9ce in rural underserved areas. The Journal of the American Medical AssociaKon. 315(9:939-942. 2. Graves, J., Mishra, P., Dibus, R., Parikh, R., Buerhaus, P. (2016). Role of Geography and Nurse Prac99oner Scope- of- Prac9ce In Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Medical Care. 54(1): 81-89. 3. Donelan, K., DesRoches, C., Dibus, R., Buerhaus, P. (May 16, 2013) Perspec9ves of physicians and nurse prac99oners on primary care prac9ce. The New England Journal of Medicine 368(20):1898-1906. 4. DesRoches, C, Gaudet, J, Perloff, J, Donelan, K., Iezonni, L. Buerhaus, P. (2013). Using Medicare Data to Assess Nurse Prac99oner Provided Care. Nursing Outlook. 61(6):400-407. 5. Buerhaus, P, DesRoches, C, Dibus, R, Donelan, K. (2015). Prac9ce Characteris9cs of Primary Care Nurse Prac99oners and Physicians. Nursing Outlook 63(2), 144-153. 6. Perloff, J., DesRoches, C., Buerhaus, P. (2016). Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Prac99oners and Physicians. Health Services Research. Ar9cle first published online: 27 DEC 2015 DOI: 10.1111/1475-6773.12425 7. Razavi M, Perloff J, DesRoches C, Buerhaus P, Clarke S. Iden9fying the drivers of cost differences between nurse prac99oner and primary care physician managed Medicare beneficiaries. 2017: Under journal eview. 8. Buerhaus, P., Perloff, J., Clarke, S. O Reilly, M., Zolinisy, G., DesRoches, C. Comparing the quality of primary care provided to Medicare beneficiaries by nurse prac99oners and physicians Under journal review

Published Studies to Date 9. DesRoches, C., Perloff, J., Clark, S., O Reilly Jacob, M., Buerhaus, P. 2017. Underserved popula9ons. The Quality of Primary Care Provided by Nurse Prac99oners to Vulnerable Medicare Beneficiaries (In press). 10. Perloff, J., Clark, S., DesRoches, C., O Reilly Jacob, M., Buerhaus, P. 2017 Associa9on of State- Level Scope of Prac9ce Restric9ons with the Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Prac99oners (under journal review). 11. DesRoches, C, Buerhaus, P, Dibus, R, Donelan, k. (2015). Primary Care Workforce Shortages and Career Recommenda9ons from Prac9cing Clinicians. Academic Medicine. 90(5): 671-677. 12. Auerbach, DI, Chen, PG, Friedberg, MS, Reid, R, Lau, C. Buerhaus, PI, Mehrotra, A. (2013). Nurse- managed health centers and pa9ent- centered medical homes could mi9gate expected primary care physician shortage. Health Affairs 32(11):1933-1941. 13. McMichaels, B, Safriet, B, Buerhaus, P. (2017). The extra- regulatory effect of nurse prac99oner scope- of- prac9ce laws on physician malprac9ce rates. Medical Care Research and Review

Projec9ng the Future Supply of RNs Good News! In 2000 we projected nursing shortages approaching 500,000 in 2020 if nothing done to increase interest in nursing Re9rement of baby boomer RNs No evidence at the 9me people interested in becoming RNs

Latest Supply Projections: Now through 2030 (Auerbach, Staiger & Buerhaus 2017, in press) Highlights: NaKonally, able to replace the re9ring baby boom RNs Total nakonal supply will increase by roughly 1 million RNs The Feds believe this growth will be enough to match the demand for RNs, at least on a na9onal basis Auerbach, Staiger, & Buerhaus (2017 in press). Millenials are almost twice as likely to choose a nursing career as were the baby boomers, but workforce growth is decelera9ng. Health Affairs 26

2,500,000 Number of Registered Nurses Employed on A Full- Time Basis by Genera=on: Historical and Projected Number of full- 9me equivalent RNs 2,000,000 1,500,000 1,000,000 500,000 0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 Year baby boomers Genera9on X Millennials Pre- boomers

Annual growth rate in the number of registered nurses (FTE) per capita 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 1979-2000 2000-2015 2015-2030 (projected) Auerbach, Staiger, & Buerhaus (2017 in press). Millenials are almost twice as likely to choose a nursing career as were the baby boomers, but workforce growth is decelera9ng.

In Sum Many strengths establish a solid founda9on for the RN workforce moving forward The Challenges ahead

Challenges Nurses and the Health Organiza9ons that Employ them will Face Over Next 10 Years 1. Many (most?) nurses are unprepared for value based care and payment 2. Uneven growth of RN workforce across the US 3. Simultaneously, RNs will face Aging baby boom genera9on Physician shortages Re9rement of RN workforce Implementa9on of new health reforms

Resekng Strategic Rela9onships to Respond Successfully to these Challenges 1. Engage nursing educators and students 2. Partnerships w nurses, par9cularly in the community 3. Engage primary care physicians and nurse prac99oners 4. Foster organiza9onal leadership among clinicians

Many (most?) nurses are unprepared for value based care and payment Don t understand what value is Not taught in nursing educa9on More comfortable with a pa9ent perspec9ve

Engage Nursing Educators and Students 1. Find a way to work w nursing educa9on programs to include basic economic principles into curriculum Nursing students need grounding in health economics and value star9ng in sophomore year extending through the rest of their educa9on Health outcomes and costs (Value = O/C) 2. In your discussions, emphasize outcomes that are important to your organiza9on and are connected to nurses Today s examples: lower mortality, avoiding readmissions and adverse clinical outcomes, preven9ng errors, infec9ons, sa9sfac9on, etc.

Engage Nursing Educators and Students 3. Costs actual reduc9on in amount or price of resources, or avoidance of lower payment/loss of reimbursement 4. No economics, no policy, no focus on value no clinical sewng for students

Challenges Nurses and the Health Organiza9ons that Employ them will Face Over Next 10 Years 1. Many (most?) nurses are unprepared for value based care and payment è Uneven growth of RN workforce across the US 3. Simultaneously, RNs will face 3. Aging baby boom genera9on 4. Physician shortages 5. Re9rement of RN workforce 6. Implementa9on of new health reforms

Despite replacing the one million RNs who will re9re over the next 10 years, and adding one million RNs between now and 2030, the RN workforce will growth unevenly throughout the country Auerbach, Buerhaus, & Staiger (2016). How Fast Will the RN Workforce Grow through 2030? Projec9ons in Nine Regions of the Country. Nursing Outlook, Nov 22, 2016

Nine US Census Regions

Regional Supply Projec9ons through 2030 (three moving parts) 1. Some states will have a rela9vely high (low) propor9on of their RN workforce over age 50 who will be re9ring in large/ rela9vely low numbers 2. Some states will have a rela9vely large (small) number of new RNs entering the workforce who will replace re9ring RNs 3. The popula9on in some states will increase at a more rapid rate rela9ve to other states

Total and per capita growth in FTE RNs 2015-2030 60.0% 50.0% 40.0% Growth in FTE RN 30.0% 20.0% Growth in FTE RN per capita 10.0% 0.0% New England Mid Atlan9c East North Central West North Central South Atlan9c East South Central West South Central Mountain Pacific Auerbach, Buerhaus, & Staiger (2016). How Fast Will the RN Workforce Grow through 2030? Projec9ons in Nine Regions of the Country. Nursing Outlook, Nov 22, 2016

Entry, exit, and projected RN FTE growth by region Region 2001-2014 Projected 2015-2030 New England Mid Atlantic East North Central West North Central South Atlantic East South Central West South Central Mountain PaciCic Ave Annual Entry Ave Annual Exit Growth In RNs (%) Growth in RNs per capita (%) 4,554 1,798 6.1% 0.0% 16,000 6,608 9.5% 8.3% 13,548 6,234 21.7% 17.7% 7,751 3,197 19.9% 16.4% 20,068 5,964 26.3% 2.9% 6,309 2,553 44.7% 39.2% 13,975 2,185 55.2% 39.2% 7,358 1,436 45.6% 18.5% 15,685 5,603 19.2% 0.7% Auerbach, Buerhaus, & Staiger (2016). How Fast Will the RN Workforce Grow through 2030? Projec9ons in Nine Regions of the Country. Nursing Outlook, Nov 22, 2016

And in Missouri, Currently 1. These are unusually good data Consistent measurement Trends 2. Varia9on across the state by region 3. Can target certain regions

All Employee Turnover Per Region All Employee Turnover State of Missouri 16.0% Southeast 24.7% St. Louis 20.6% Northwest 17.8% Central 17.2% West Central 17.2% South Central 16.4% Northeast 16.2% Ozark 14.3% Kansas City 13.9% Southwest 13.4% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Nursing 20.0% R.N. Turnover (Employee) 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% Missouri 6.0% 4.0% 2.0% 0.0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Nursing 18.0% R.N. Vacancy (Employee) 16.0% 14.0% 12.0% 10.0% 8.0% Missouri 6.0% 4.0% 2.0% 0.0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Nurse Staff (RN) Turnover (Employee) Nurse Staff (RN) Vacancy (Employee)

Nurse Prac99oner Turnover Metropolitan Areas Metro Number Separa=ons Total Number Employees Turnover St. Louis WIA 31 466 5.6% Kansas City WIA 43 480 8.3% Missouri Total 81 1183 6.1%

Nurse Prac99oner Turnover (Employee) 10.0% Nurse Prac=oner Turnover (Employee) 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% Missouri 3.0% 2.0% 1.0% 0.0% 2012 2013 2014 2015 2016 2017

Nurse Prac99oner Vacancy (Employee) 12.0% Nurse Prac=oner Vacancy (Employee) 10.0% 8.0% 6.0% Missouri 4.0% 2.0% 0.0% 2012 2013 2014 2015 2016 2017

Behavioral Health Nurse (RN) Metro FTE Vacancy Employee Vacancy Employee Turnover St. Louis WIA 24.9% 25.2% 16.1% Kansas City WIA 8.5% 4.8% 26.7% Missouri Total 15.1% 12.3% 21.4%

Engage Nursing Educators and Students 1. Find a way to work w nursing educa9on programs to include curriculum incorpora9ng basic economic principles Nursing students need grounding in health economics and value star9ng in sophomore year extending through the rest of their educa9on Health outcomes and costs (Value = O/C) 2. Discuss outcomes that are important to your organiza9on and are connected to nurses Today s examples: lower mortality, avoiding readmissions and adverse clinical outcomes, preven9ng errors, infec9ons, sa9sfac9on, etc. 3. Costs actual reduc9on in amount or price of resources, or avoidance of lower payment/loss of reimbursement 4. No economics, no policy, no focus on value no clinical sewng for students 5. Meet with the Dean and faculty twice each year, even students Explain what is happening in health care Describe ac9ons your organiza9on is taking to respond Discuss implica9ons for nursing, ways for mutual gain 6. Talk with and try to understand Millennial genera9on Expecta9ons, sa9sfiers, dissa9sfiers elicit their involvement

Challenges Nurses and the Health Organiza9ons that Employ them will Face Over Next 10 Years 1. Many (most?) nurses are unprepared for value based care and payment 2. Uneven growth of RN workforce across the US 3. Simultaneously, RNs will face è Aging baby boom genera9on Physician shortages Re9rement of RN workforce Implementa9on of new health reforms Buerhaus, Skinner, Auerbach, & Stagier. Four challenges facing the nursing workforce in the US. Journal of Nursing Regula9on (2017 in press)

Aging of the baby boom genera9on 76 million Americans gaining eligibility for Medicare about 10,000 each day Will go on for more than 2 decades Mul9ple chronic and degenera9ve condi9ons Will increase the overall demand for RNs and the intensity of nursing care required

Must Acknowledge Nursing clinical workforce can t, by itself, provide all the care that will be required Nursing educa9on unlikely to develop geriatric programs Content never popular w nursing students

Encourage/help/work with nurses to form partnerships with Social workers, pharmacists, community health departments, primary care and other physicians, community health workers, hospitals, churches, home health care agencies, long- term care facili9es, and emerging health care delivery systems, etc. Understand the scope of need among aging baby boomers in community and to determine how best the above assets can be organized to provide a more coordinated and efficient system of care delivery

Challenges Nurses and the Health Organiza9ons that Employ them will Face Over Next 10 Years 1. Many (most?) nurses are unprepared for value based care and payment 2. Uneven growth of RN workforce across the US 3. Simultaneously, RNs will face Aging baby boom genera9on è Physician shortages Re9rement of RN workforce Implementa9on of new health reforms

Shortages and uneven distribu9on of physicians By 2030, shortages es9mated up to 105,000 na9onally 1 Between 25,000 and 36,000 primary care physicians Uneven distribu9on On the eve of the ACA s 2014 health insurance expansions, nearly 60 million people had inadequate access to primary care, and HRSA reported 5900 health professional shortage areas in the US 1 Kirch & Petelle (2017). Addressing the physician shortage. JAMA hbps://doi.org/10.1001/jama.2017.2714

What to do? Two approaches NP and physicians RNs in primary care

Work with NP Leaders and Physicians Rather than viewing the liring of scope of prac9ce restric9ons as a fight between nurses and physicians over autonomy, help NPs and physician leaders work together to envision a rela9onship that allows for the evolu9on of roles and prac9ces that make sense to both clinicians respects each other s strengths, and ul9mately leads to a reconfigura9on of the workforce that is more responsive to the health needs of Missouri, par9cularly in rural areas and among vulnerable popula9ons

RN level expand produc9ve capacity Assuming you agree about the need for a stronger primary care system, then Embrace the Macy Report, urging among other things Expanding the number of RNs and their roles throughout the primary care delivery system Back to nursing educators: Increase primary care content and clinical experience in undergraduate nursing educa9on Macy Founda9on report, Registered Nurses: Partners in Transforming Primary Care (2017)

Registered Nurses: Partners in Transforming Primary Care: Atlanta, July 2016 Chaired by Thomas Bodenheimer, MD, MPH & Diana Mason, PhD, RN, FAAN

Challenges Nurses and the Health Organiza9ons that Employ them will Face Over Next 10 Years 1. Many (most?) nurses are unprepared for value based care and payment 2. Uneven growth of RN workforce across the US 3. Simultaneously, RNs will face Aging baby boom genera9on Physician shortages è Re9rement of RN workforce Implementa9on of new health reforms

One million RNs will be re9ring over next 10 years One- third of the RN workforce Millions of years of nursing experience leaving the workforce each year Buerhaus, Auerbach, & Staiger, May 3, 2017. hbp://healthaffairs.org/blog/2017/05/03/how- should- we- prepare- for- the- wave- of- re9ring- baby- boomer- nurses/

Number of Years of Experience Lost to the Registered Nurse Workforce, 1979-2030 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 Years of experience leaving the workforce (actual) Years of experience leaving the workforce (projected)

Hospital CNOs, pa9ent care unit managers, and human resource officers An9cipate and act to prevent the nega9ve consequences that could ensue as RN re9rement accelerates Gather informa9on on nursing workforce to ascertain when and how many RNs are expected to re9re and iden9fy the nursing units, departments and pa9ent popula9ons that will be affected Share this informa9on with physicians and other clinicians who will be affected and seek their involvement in mi9ga9ng poten9al harmful consequences

Fostering organiza9onal leadership Work w department and unit leaders to engage soon- to- be re9ring RNs to learn what can be done to delay their re9rement Create programs that bring older and younger RNs together to iden9fy the knowledge and skills needed by rising RNs that can be imparted by older and more experienced RNs Strengthen succession planning to assure that re9ring nursing managers will be replaced by RNs who are well- prepared to assume management of clinical and administra9ve opera9ons on pa9ent care units Offer opportuni9es to re9ring RNs to fill new roles in community engagement, pa9ent naviga9on, or educa9on and preven9on

Insights on crea9ng leadership within organiza9on Leading Clinicians and Clinicians Leading Richard Bohmer, The New England Journal of Medicine April 18, 2013: pp 1468-1370

Fourth Challenge: Emerging Direc9ons for Health Reform? 1. Decrease costs Increase consumerism - (e.g., Health savings accounts Cross state insurance purchasing) 2. Eliminate personal and corporate mandates 3. Medicaid block grants (pull back on Medicaid expansions?) Let states decide, innova9on 4. Expand insurance coverage Con9nue to allow children up to age 26 to remain on parents health insurance, con9nue to ban insures from excluding enrollment based on pre- exis9ng condi9ons, tax credits(?) 5. Maintain efforts to transi9on fee- for- service payments to value based?

Preparing for Health Reforms Work w educa9on systems, fund speakers, educa9on series, etc., to increase awareness of health care policies, health care systems, and health reform content in nursing educa9on Skate where the puck (pa9ents) is going to be help educators and students know where the puck is heading Focus on developing a value conscious mentality provide examples to students and faculty

Thank you